0010-026 (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
'
�i
F?'° fe�sI nals Code, and my License is in full force and effect.
cense # Lic. Class Exp. Date
574177 A x!3/.31/2.1
Date ^ ��,Signature of Contractor_•�
W Ile—
OWNER-BUILDER DECLARATION.
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for,the following reason:.
( ) 1, 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).
( ) 1, 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 -tithe <following declarations:
O 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. „
(F 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.
W.M. POND
(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 becorn6'sObject to the
workers' compensation laws of California, and agree that if j should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provlslo S.
Date:` �� :w7 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 representatives of this City to enter upon
the above-mentioned property for iiinspection purposes.
,,Signature (Owner/Agent) - '' • �> --- --- Date i ,�
BUILDING PERMIT PERMT#
DATE VALUATION LOT' t3gai-,� TRACT. .
JOB SITE t
APN
ADDRESS
;57-3" Vii. JUr A1itDFUMS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
GTEVE1fiiiTNUMP.TIONMIS —• - -
"i` T k :f Ai'+G�t��n".�K17C;��C31�:r9�f�.::
1,61 DIDIANAPAM
73pI I CODITMY MUB DR, SUM 1?4
CA 92504
PALM D S� +.T CA 92260
, .
1176()346.4032 CBLA I W.
USE OF PERMIT
tom, (;lLCt AL POOL - COIAI0014 P RHKA POOL
POOL ANDJOR SPA 1.1131
1 IMM cour Ole CONSIN CTION
36.000.00
PLAN (14FWX PEE 103-000-439-318 $2101n
COlriS'4 RUIC,TION FEE 101-000-41&-000. $923.50
Mi?!p�(A:ilf���p�la7�3mr;#,I, IT , __ POOL101-!/��€y!t/}��, 21-L0?[C�?,0
'101-000�S+�?Sd,C�e�ttl
QPXEC i RFfCAL �'l:9 an POOL 1 01 -000-420'-000 $45.00
P1.bI14AUNG ..W.. =- POOL 101.000-419't-000 W100
KUB" -'TO AI, COMET Rii•CTION ANIS PLAN C:lE Y M,
$629.18
= PRY, -PAID S
S0100
... ' •
int �7PrSs Durnow
1. iFJ ?nddv'.A7Lr
s ; j DST 2 6 Zp00
48629,70
a i y '%J
RECEIPT
DATE - r
BY
DATE FINALED
INSPECTOR
INSPECTION (RECORD
0.11 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
CasTc
PLUMBING APPROVALS
F
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
'
Gas Test
Appliances
Final
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)
ci o La. uinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety, Department only
1g fter approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Commercial Pool - Lot E - 57-320 St Andrews
Applicant Contact: Steve Dodson Pools - 760 346 4032
Application / Circulation Date:
Community Development Department
Christine Di Iorio, Planning Manager
Public Works Department
Steve Speer, Senior Engineer
Building and Safety Department
Greg. Butler, Building and Safety Dept Manager
/1�0110/00 NJG
Date
10 23
Date
Date
Date
City of La Quinta
Developers Project Approval Form
�/ia4uC k�C�
FILE
Prior to the issuance of Building Permits for -the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
mer approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Commercial Pool - Lot E - 57-320_S A7ndrews
Applicant Contact: Steve Dodson Pools -.760 346 4032
Application/ Circulation Date:
Community Development Department
Christine Di Iorio, Planning Manager
:10/10/00 NJG
Date
Date
Public Works Departmen
O. />
Speer, Senior Engineer
Building and,Safety Department
Greg Butler, Building and Safety Dept Manager
111151,0 1 if:)
D to
Date
f IIIECIRCULATION1 UIP ENTCOMMUNIJ
PA
FACILITY- DBA: 2. 3
OWNER'S NAME -
PH
ig
S ate
Gyanufa
.low -at GPM
j good worm 5. ',Provide h
4. Prni or; less
04
Spa tem Skimmers
04 WoAd" 16"
D in
9 tablet
POOL SHELL/RtLATED FACILITIES
ac e
Provide the following in clean condition/ 0
GATES AND FENCING
to.' :Pool shell
Osed with
U in TOT EfOLIIOWING�'p*
cessh
FIESTROOMS
SHOWERS DAESSIhG'-ROOMS 'y �Tow�.
wing, n good iep'air and. ea 91"Viter
ST
missing d
ght
actually q-
sa
ADDITIONAL Vl*'
ND/OR REMARKS
RECtiv BY:,
ED
REFER Ta REVERSE SiDE FO
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LATION
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