0002-229 (CP)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class J Exp. Date t
?7141127
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compehsation�ovisions of Section 3 = of the Labor
Code, I's II forthwith comply -wit Ahose,proSislo 's 7 .
Date: 71� ``` Applicant / ��
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize`_F e'presentatives of this City to enter upon
the above-mentioned property for i sp°ection p°ur�oses-- —
Signature (Owner/Agent) S
PERMIT#
BUILDING PERMIT C11- ,lila
DATE 119aVALUATION (��� ��Yh'✓f�v7� LOT TRACT
JOB SITE ADDRESS jis�'4:�CFiXs'.fG�il°. APN
OWNER CONTRACTOR/DESIGNER/ENGINEER
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f t-'1'11.ff f 0.a.
USE OF PERMIT
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1(>CAL DUE NOW I
RECEIPT I DATE I BY
j
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Sit Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills'
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings 7Main
Drain r
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
400,
Underground Plbg. Test
Final
Gas Piping o4 -
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation rpp
Gas Piping
Gas Test
Appliances
Finalftw ci �®
i
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
11
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
District Environmental Services Division
POOL AND SPA PLAN CORRECTION
District No. Plan No. 5! /ne- Date /;Z
PROJECT NAME )R�l\. a. (—c". t f Thr n • <
c
PROJECT LOCATION
OWNER / CONTRACTOR
The plans are now approved subject to the conditions listed below.
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CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre-gunite and pre -plaster inspections at least three (3)
working days in advance. ,
A FINAL INSPECTION MUST be made upon completion of all work including fencing, safety equipment, and signs.
APPROVAL to operate shall not be granted until the facility has passed the TINAL INSPECTIONS and "APPLICATION TO
OPERATE" has been completed and PERMIT fees have been paid.
REQUEST FOR FINAL INSPECTION SHOULD BE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
Plan Check By Phone ( ) G c7
I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction:
N
Signature__/
Company o. 0 66'v
Date
DOH -SAN -181 (Rev 11/95) Distribution: WHITE—Office; CANARY—Applicant; PINK—Bldg. Dept.
RE
FEB -25-00 01:38 PM DODSON POOLS 7603410895 P.01.'
00040GI
STEVE DODSON CONSTRUCTION , INC.-
General
NC:General Engineering Lac, 574127
73011 Country Club Dr. #F-4
Palm Desert Ca. 92260
DATE/TIME; Z.Zi.cva/,(' 3 C
FROM; rr-
COMPANY /CONTACT;
P.O.#.
PHONE (760) 346-4032
FAX (760) 341-0805.
JELECOPIER COVEEI SHEEI
r
TOTAL NUMBER OF PAGES ( INCLUDING COVER SHEET)
COMME M -._ ---- �L�` �
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FEB -25-00 01:39 PM DODSON POOLS 7603410895 P.02
FEB -25-00 FR I 14:07 JNDIO ENV. EEALTH FAX N0, 7808638303 P. 01
COUNTY OF RIVERSIDE HEALTHSERVICESAGENCY
05PARTMENT OF PNVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPP; ;MI:NTAAL}REPORT T SAN. FORM # DATE
SU6J(dCT ' L�V�.C�_ c� _ _ PERMIT NO.
V
INSPECTOR 1 -
REMARKS.
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Ski - -si
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FEE -25-00 01:39 PM DODSON POOLS
760341,0895
/** ' 1-0-. '
P.03
Co" -17-0-F RIVERSIDE HEALTH .SER CES AGENCY
1. DEPARTMENT OF ENVIRIONMENtAL HEALTH
ENVIRONMENTAL HEALN SERVICES
SUPPLEMENTAL REPORT TO SAN. FORM DATE L/2-7-/00
SUBJECT t n V C r-V71� (,1 IN, PERMIT NO.
ADDRESS
INSPECTOR
REMARKS: c r
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0, JQ'��Aj .4,g V IA. IA
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DIsiflbutlon: WHITE -.Office; CANARY—Owner; PINK MCe
3-25-00 01:39 PM DODSONIPOOLS 7603410895
P.04
1
CO N OF RIVERSIDE HEALTH SERVICES A NCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES `{
SUPPLEMENTAL REPORT TO SAN. FORM # DATE
SUBJECT N c1 ca ry .i rtki��: ,g PERMIT NO.
ADDRESS
I SPECTOR
REMARKS: { e
• � � .r
4�
c�r+•9ar�>>. l�arueBl DletribuHon: WIfTE—Of loo;. CANARY—Ownor; PINK --Of ice
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Af
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c�r+•9ar�>>. l�arueBl DletribuHon: WIfTE—Of loo;. CANARY—Ownor; PINK --Of ice
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FEB -25-00 01:40 PM DODSON POOLS 7603410895 P.05
IN - > RIVERSIDE HEALTH SERVIC ', -. GENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
District Envlronrrtental Services Division
POOL AND SPA PLAN CORRECTION
District No, �'1'" Plan No.
PROJECT NAME V�II�I\c� �Q I r W (lt f-5
PROJECT LOCATION �d�OW~ C'Q. C(e
OWNER /CONTRACTOR __A Df1 cQ,� n u Von() 1S
The plans are now approved subject to the conditions listed below.
16 (111V M,001v_ LT (Ac� I AO ?'D I'L4 01,4_ fl 410 9)1-
a+ o� cfn CLA
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,� i 4ek • a cQc�r'tc C o /J r
ea. � c r ,'LA
CONSTRUCTION INSPECTIONS: Contact the Plan Checker for pre-gunite and pre -plaster inspections of lamt 1hree (3)
working days in advance.
A FINAL INSPECTION MUST be made upon completion of all. work including fencing, safety equipment, and signs.
APPROVAL to operate shall not be granted until the facility has passed the FINAL INSPECTIONS and "APPLICATION TO
OPERATE" has been completed and PERMIT fees have been paid.
REQUEST FOR FINAL INSPECTION SIHOULDPE MADE AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
Plan Check By C/ Phone ( )d',o,7
I acknowledge the corrections noted herSO-aqd as Indlcated n the plans and agree to Incorporate them during construction;
Signatu?trr-'�T -C -7 "' -4 116LA
Company' �Oi.�SY�OL-
Date
DOH -SAN -18t (Rev 1