0302-173 (RPL)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 # )) yy11 �rrLic.. Cl�apsss7S Exp. Date
pate w~ W '- Signature of Contracto
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.
'14) 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 STATE FUND Policy No. 162108-01
(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 provisions of Sedion 3700 of the Labor
Code, I shall forthwith comply with,those provisions, t
Date: 2. • "��J r;" s Applicant �x rAe±• .t (.� .1" .+�
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 applicator 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
th `a`bove-mentioned property for inspection purposes.
;t _.ra
�Signature,(Owrier/Agent)i��'' Dater 2 44.43
BUILDING PERMIT PERMIT#
fy-30247
DATE VALUATIONj,,�D;D�,1Q LOT TRACT
f /
JOB SITE r
ADDRESSJ.�.379
-
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
WIM11011111' PSL 14ER s, ILC
.PAL PA171.1FIC FOOLS
til -135 al EIM--00C,X I -I 1A
39.301SAIDUM CD3' MT, 0200
LA. Qr'tjN X..A- CA 92253
TIAL;r74; ,3 .a1 IR"r CA 92211
(°isJ0323.4782 C S1.,ff 6219
USE O�+F� PERMIT
.C"OOL.lfliu IVOR �N asPA
POOJ.J PA. RLAR14,DARRI RS SHALL BE .IN PLACE AT 4=Rh`rPLASTZR
rNSPECTICSN, EQUIPA/JNT EN01,0011RE NOT fivif„" UDIVir. .
P4,C?J.,.f.3Npff,1.R SRA 40,00,00 LS
X57MMD C'Mr 010 CONFIRUCT.1007
40X0 €i
PLAN CHECK FEE 101-000-439.318 SIVI. 18
C:L ASYVIUC;Ted. N Rl E 101-D0O-418-000 $149.50
MECHANICAL PRE -- MOIL 101.000.421.000 $7A.00
Ei.W9 RICA L ME -- POOL, 101.000-420.000 143.00
1'1.i1W'INIG FLT ... Pool, I (il -000-419-000 $27,00
.,3��;
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$61711.68
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D TAL 1 `1 O&M FUES DUE I4��d
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a
RECEIPT DATE ---___J :�;'
BY
DATE FINALED
INSPECO
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L - INSPECTION RE
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test_
Final
Gas Piping I v-01
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 2
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:
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5fi'EG I F I GAT I ON5 REVISIONS DATE
POOL SPECIFICATIONS
RAISED BOND BEAM AT IS
SIZE �� [—(o -n X
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RAISED GOLD WATER POOL AT
I
18 WITH CONCRETE GAP AND G 130
RAISED SPA AT 18 WITH CONC. T. 631 5� PER.
SQ F
X 45TAIR5 P SPILL LL GAP AND 4 X 4 STAIRSTEP SPILL GOLD POOL 102 S.F.
PIS FROM
BACKHOE PER 41,-0
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SPECIFICATIONS
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EXISTING,L BooSTER PUMP WHISPERFLO SIZE 2 i-'iE RUN
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1 WE HAVE E REVIEWED TH15 PLANA D
/ N HEREBY APPROVE
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