9831-037 (RPL)LICENSED CONTRACTOR DECLARATION
s ..I,f a;eby affirm under penalty of perjury that I am licensed under provisions of
Chepteri9 (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 Exp. Date
^ti05 C°53'" 7/31/,00,
.Date Signature of Contr ca torr,
OWNER -BUILDER DEC)ARATION
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:
Cartier 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
subj7t i the workers' compensation provisionsrof Section 3700 of the Labor
Code, I shall forthwith comply with tho�se/provisions.
ate: ' Applicaftt-. 107.VP V
Warning: Failure to secure Workers' Compensation cove_rage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT .Application is hereby made to the Director of Building and Safety
for a permit subject to -the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to ,
any permit issued as a result of this applicator agrees to, & shall, indemnify '-f
& hold harmless the City of La Quinta,'its officers, agents and employees.l ,.
2. Any permit issued as a result of this application becomes null and -void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and,State laws relating to the building k
construction, and hereby authorize representatives of this City to enter upon.
the above-mentioned property for inspection purposesd�.
'ISSgnature (Owner/Agentt {"- ""7 �%( Date
/.
k. PERMIT # �•
'
BUILDING PERMIT��_�,
DATE 1 VALUATION � 9® LOT *' TRACT
141�
(
It
ADDRESS 55-279 TA N4�'UCIN+YC'.YO D
APN
• t+ .
OWNER _
CONTRACTOR / DESIGNER / ENGINEER
A WE.0 RES1DEN 1"1+Md ASSN' MC
RICH P.A€ ZIN IStC.1'' POOL$
PO BOX Iwo
570 OLEANDER RD
1;.A QU1N`TA CA 92253
PALM SPRINGS CA 92263
('760)3214-58+27 "C':l31:,1t 971.
-USE OF PERMIT
P00%, ANVO)2 SPA
NEW C011Z?iCN AREA POOL & SPA.(R2EPLACING PREVIOUS P001. lie SPA..)
NOTE: V t(3V'Nl:/D, Ar; C'ESSP1 LE, ROME, OF IXAM TO POOL AICiR-
N�i`K%L AND/OR ,Ptd. 4i .00.00 L3
tn�i'�'IALAI A) COST 0349 C' ?�1STRUC`°I:.xl
�J,E�U;.tld3
f'U;ri UT 6s+ V M' SUMMARX'
i'l.AN d" E{(iC1+..FYX \` 1014)00-439-3:15 $22'1,18
; AX711ANv.l•CAL MIM POOL 101-1200-:421.-000 524.00
" >
Zil"FMUCAL 1.EE -- POOL 40.1 4300-•'120-000
F l..►3141PN.fzwG FEE, -- I't'sm 101-f.K20-4191.0130 $27.00
fq
CONS�"!'it.f.TC ON ,AND PIAN c *Mt, .K
�!2•i►S
LESS PRE --.PAID FEES
$0.00
iOUL .1101,ItIVI T YCE's, DLIk. NOW ,
$672.64
- 2
ALRfi
RECEIPT
DATE
BYWDATE
HNA LED
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final f/ 6
COMMENTS:
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)
1,.�,sd.�,yiY�+y�•�n..:-�t.9�".��b..�y�'fif •' •!y'��) � F,�,:�f'4-; i.S..l.r,%i'
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
POOL AND SPA PLAN CORRECTION
r � t
DISTRICT # PLAN # 01,)
// k/%
- DATE
PROJECT NAME V` G �A) i 6� r
PROJECT LOCATION S �S '�%�> Ir�,,�Fwn��1
OWNER/CONTRACTOR-a tr 2 U."S 1. POO S
The plans are now approved subject to the conditions listed below:
ro
r nk:. <� I ek t•� n <o!r\+f C �I+� r.f (;.S�C#r.�. f,�,ly.'i C
t
nn''1
AkofF S "o C', I N,..A�YT. i s'tP,p 4c
A i
Cl P O� 1�� C. ay_�r r+,.1" JlDrz 0 C,) r (,a
(� +
c,W0Q C ine.
\ 3 jC+ I S ) S cl (a Cy �.� T G +r lcr%
Q&,-
16J S�9[]0_Ir N�Ao Cl �n tw\ � � ��M.lo S �nC� , it•1\.S � {nG .0 C �f� +%Jsy� %�
-�AIAAc1\rc, `*Cl.ti., �ul),A!aA��QCr ltd �� � I'�'�t. `�(�M nC�'(1Q�srC�C)r•-1
e
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 FINAL INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT fees
have been paid.
REQUEST FOR FINAL INSPECTION SHOULD BES E AT LEAST FIVE (5) WORKING DAYS IN ADVANCE.
PLAN CHECK BY J . y t -mac ��-r' c- Phone ( ) C\ 6 ? -- � a _
I acknowledge the corrections noted herein andjas>indicated on the plans and. agree to incorporate them during construction:
l
Signature
Company e"C-)-s Z
Date ��� •" 9�
DOH-SAN-181(Rev 1 X92)
W -OFFICE — Y -APPLICANT — P -BLDG. DEPT.
CITY OF LA QUINTA SUB -CONTRACTOR LIST
PERMIT NUMB OWNER riu 96`5. BUILDER__&,_!�P
1013 ADDRESS55ER_ q9;JL_o--3Z__
'his for� shall be posted on the . job with the . Building Inspection Card at all times. an a conspicuous place. Only persons appearing on this list or their employees are authorized to work
9'rhis job. Any changes to this list must be approved by the Building Division prior to commencement , of work. Failure to comply will result in a stoppage of . work and/or the voidance
L_ A :._s..,....,*;-- --_+-A k -l—, mfilet do&-nmnintarl h%1 2nnlinant "0n Fila" is not an acceptable resDonse.
if building permit. For
eacn applicaule Lraue, all
LJVIIWVV It—
04 ompensatio'ri Ipurance
Carrier Name Policy Number Exp Date
(e.g. State Fund, CalComp) (Format Varies) lxx/ x /xx)
Cit`yBusi4s
License Number,
lxxxx)
.:
License
se
Exp. Date
JJxxJxx)
Trade Classification
Contractor
Classification
le.g. A, B, C-8)
Contractor: tractos Lacense ::
License Number Exp. Date
(xxxxxx) (xxixx/xx)
Company Name
EARTHWORK IC -12)
CONCRETE I . C-8)CE
C
NA ld 7- Z;�IV41 M 7�-D
(212, C 4 2-
4 7'/T_L�
S r4-ld5_ FL1AJj)
2-IL14 Af 9 - 5-:29
-00 24
2.3, -99
51,04
7- 2-3
FRAMING IC -5)
STRUCT. STEEL (C-51)
MASONRY JC -29)
PLUMBING JC -36)
C7Aqr-;U0S0 fe"
C.53
6 7L 9,rV
-3o. 11
—
5 rsbiol
12--17-09
LATH, PLASTER (C-351
DRYWALL (C. -S)
HVAC IC -20)
ELECTRICAL (710)
ROOFING (C-39)
SHEET METAL (.C-43)
FLOORING IC -15)
77-777-777-7.
GLAZING IC -17)
INSULATION (C-2)
SEWAGE DIPP.. (C-42)
PAINTING IC -33)
CERAMIC TILE (C-54)
0 7-t- tE
C5f
37 -)_6 q
i I-9 `/
52-S-0
CABINETS IC -6)
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
ew Pnw- -2- AJ S
C S3
y3) 0,_rS'
A4 pl-
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