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9511-042 (RPL)N `1" LICENSED CONTRACTOR DECLARATION I hereby affirm 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. 574127 A 8.13.i/95 License # Uc. Class Exp. Date Date 11 )) , ,—,– Signatureof Contractor OWNER -BUILDER DECLARATION I hereby affirm 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 n•,•..t•t+�rt•r - Policy No. •n.n�»nr�+ (This section need not a completed if the permit valuation is foi �1 0.00 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 provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 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 underr or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, 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 representatives of this City to enter upon the above-mentioned property�for Inspection purpr"%3: ' Signature (Owner/Agent) i !/i,,A i,1. A _,kDater- ALCM:; - BUILDING PERMIT PERMIT�,�-ti�2 DATE 3.. 'V(Y:) VALUATION Z 14,91fti, LOT TRACT JOB SITE ADDRESS 7 65 SOT.iY+',3 A WAY APN 41564-152-006 OWNER CONTRACTOR S'Y'EVP,. DODSONY CflieiSTRIIMON �C.)UC'LAS I N T1vIF�. L 68305A PEREZ RD, 0.9 78865 SONES'1°A WAS' CKf EDRAL MY G.A. 92234 LA QUINTA CA 92253 (619)324-1232 C13L# 1044 DESIGNEWENGINEER USE OF PERMIi'� C),t'WD/Oil r�7 �A IXX)L AND SNA FEE DESCRIPTION FEES P001, fes;©/OR SPA 14,000.00 ,LS M IACU E.D COST OFF COYNS x RUC, I lGIN 3.a,,;;aMAO :f''i:AN CHECK. nF 101.-000439-319 $99.45 CO14S17RUC7f(ON M 10.1-000-418-000 $153.00 ivtl: CHAWCAL'FFX- -- POOL 101-000-421-000 $24.00 E,LNt;T12.iCAL FEE -- POOL 101-000-420-000 545.00 PLUM131NOr •-POOL 101.-000419-00(1 S21.00 4 �, p�I 0 9 1995 y _ - SIM -TOTAL CONST'R(.fMION AND PLAN HECK ----- S348.45 LESS P& -PAID EE.ES $0.00 TOTAL PE4i:I8 IT :IFEES ] E', NOW A . -45 $343-45 t RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set 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 Wali Firewall Exterior Lath Drywall - Int. Lath • Final Final BLOCKWALL APPROVALS OLS - SPAS Steel 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 OX 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) COMM NTS: CO r. �✓�W ~ �X� 6_4„t tom- 4�,� �t` ins �Oo( L vv/Jrt.QSS'," /' i /Q►� C� U l !' �V,,� , 41 ' % �"p�S A Ly'�� � V �•G'(`L�, �"1 l• �^ `,y�,e�5 til 0. ff E. Fl, POOL AIRE TO BE U-IC-LOSED BY 4C FU E 5 M I N I kAl I.) M FT. L1151GH, -FENCE. LOSI NGP F OL EL _C fj F-CLOSINGP EL 'sIS L _ BBQ UMT ALL GATESi TO ISE I S .LV L _L T ATCHING. NOT BY 'k 7 AND SELF�L DODSON f w POOL ci SPA -HF JS WIPC S 0 DATE ACCEPTED F SUBjECT TO i AND ALL AP A uu NTA y f 'q, Ul 10NALLY, CONSTRUCTION TALUMON AS-RER -:)EL REY ?L111 -1k f "TIFTE DEL ��.E�COIJS BY----------- Nq 13W, �l I 7 P.L. OV A Kt A, :�A [SZD F -r- - 100 WAI-S i_SiAA=E CUSTPE:4ME-ER &Z TRI �-EVEL S -::A -S T�-t 3 ZE GROUP 3 22- ?4- 27 T!Lf- ---<)-L OR CHOICE DAMVVALLWIDTt- (I:' X 10 I B A CKH 0 E ACCESS --- ume.weir A.Wress. 7:8S65 Sonesta aw-- La Quintao Ca. M, POOH 710'! COUN-7RY C -L::: PA! -v CESER.7. CA. 9?26C P.L. OV A Kt A, :�A [SZD -31 TO -Sli -r- - 100 WAI-S i_SiAA=E CUSTPE:4ME-ER &Z TRI �-EVEL S -::A -S T�-t 3 ZE GROUP 3 22- ?4- 27 T!Lf- ---<)-L OR CHOICE DAMVVALLWIDTt- (I:' X 10 PAISE BEA9 IS' Gt'+6" wftilt SPI-LWAY SiZE ' 12" x XPIPC CAIN -'EVER 92! STAARD 6" STI PUPS OPEN -NN-CLOSED rWL COAD7(' 12.300 Gk -S 4 PUMP CAPAr-ITY 947 (P+,, ET --z N113TOP HP STA SYSTEM 3 2,0 Sq F-. W.I. FF -N -(,F- 62'LON.(;4'TALL 1. _FF—R F1 --R RAJE —190 DOIL -BlE Y(REMOVABLE GATES/ TURNOVER 2—l;HR5 A.NrDACCRC-WSR4n0) RHT -R4 L*NES.YP-'.;- SPRAYHY-ADS +S5' PLUNT9 MAw ckAlr, A ErJMrOE:; MODEL McAL !�-dR CR-:h-VA-VEFOR H EA -Tf� FU R U S tZ E 2-;0, tl 0 0 BTU GASYqE 33' PCCL LIGH1 400 SPA LQAT OKI 'AOa- , 24MR 20 V L:-Ic-r R S. D. C. 1 -4 7' =.LEc-rR-cA: rc BY: s.D.C. TV :QPIPJ DECKIAG BYS.D.C. 680 SOFT iKOO.L DECKING Wil -2 'STEP --i 2CNTRA--70� ca.-inot assjme -esp::nsibitity for-dwage to curbs, 51 dewa ks, drMaways, :e -mew- s abs, sewers, vafls, spndei-s, I n=s ::r shr(.bs.'Wien k6Rss � rrade 11-migh a neighbor's property i-. is mdets-. z:oJ- that you, ;-le ove-:er. ell- 7.�j^ iavE that re 9 -bar's per-ms5zon and assurre fd) -:!sprrisi*,-i iLy. B A CKH 0 E ACCESS --- ume.weir A.Wress. 7:8S65 Sonesta aw-- La Quintao Ca. M, POOH 710'! COUN-7RY C -L::: PA! -v CESER.7. CA. 9?26C