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0008-349 (RPL)LICENSED CONTRACTOR DECLARATION Lhereby 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' ode, and my License is in full force and effect. License # Lic. Class Exp. Date t 1 73 4 Date Td:gSinature of Contractor - t %----'� 1 -f '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 STATE FUND Policy No. 229-00.00111334 (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' compensation provision of Stection 37.00 of the Labor Code, l,sha fo i tri h comply�wi h th se to Date: dA Applicant -W ��\ Warning: Failure to secure Workers' Compensation co rage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth, on his application. 1. Each person upon whose behalf this application is made & each personaat whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if .work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State Irs r lating to the building construction, and hereby authorize yepregentehive of t Is Citi to enterupon the above-mentioned pro ertfor I s ecti • n^pu po es. o��Si nature (Owner/A ent•Y� Date: BUILDING PERMIT PERMIT# DATE' �+ . 1 �OVALUATION LOT +'S--349 TRACT E,{{tt j us"01t3 00 JOB SITE` APN ADDRESS 804"Ls ►WAI,1�'S11 DAY OWNER CONTRACTOR / DESIGNER / EN (NEER C'.F�1`l IiUA 14AT. HAMPTON' dba VACAiTON POOLS 2280 WAR'1:?:C.OW QRCT.,,, SIMM 150. 9522 DONALDS©N RD, C."OR.ONA. CA 91720 LUCERNE VALLEY CA 92356 (909)248-6045 CBLA 4335 USE OF PERMIT POOL AND/OR i1PA POOL & SPA ONLif•.d;1�AMRS MARRIE S SHALT. BE IN PUXEAT PIS$ PLASTER, rPisPECTION.P00L EQUiPk� ENT ENCLOSURE IS NOT 1..101CLiJDED IN THIS PERMIT POOL ANWOR SPA 1�000,g0 W Eb.i MAJrKD COST' OF C`OJIT,S'.t UG'7 ON �,�,uwlo l PERNM FEE SUMMARY PLAN CHWs. PEE 101-000-439.318 $10$13D CONSTRUCTION FEE 101-000-x[18-000 $162.00 MECHANICAL FU-- POOL 101.000-421.000 $24,00 ELECTRICAL, WEE •• POOL 101 w=-420000 $43.00 PLUMBINO PEE- Pool, 101-000.419.000 $1,00 k m, a' r SUB TOTAL Ci�Jn�B'1�dSTL�'SON Ab1]:11�^LM C lIM(`,'7'i��. $363.30 L'EM PRE -PAID Twn $0.00 TOT!A.-.+ P R r YMS DUE TTOW AUG 2 4 2009 CITY 0� RECEIPT DATE T BY d ; DATE FINALED INSPECTOR Sinnature INSPECTION RECORD OPERATION S DATE INSPECTOR OPERATION DATE INSPECTOR ' BUILDING APPROVALS MECHANICAL APPROVALS Se; 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 Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping 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 Gas Piping Gas Test Appliances Final / 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: