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9901-012 (RPL)LICENSED CONTRACTOR DECLARATION wl-hereby affirm under penalty of perjury that I am licensed under provisions of dkAi ter 9 (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 i� Exp., Date 7,11005 C-153.�/ 4130100 vDate //1.; 4" �Signature of Contractor 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 ownerrof 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 re;:Carrier Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). (V 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 Coli. e I shall forthwith comply with those provisions. ate: .. � f Applicant efl�eA es 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 propertylo'r inspe t'Iron purposes. V,Slgnature (Owner/Agent(f�/-�_ BUILDING PERMIT PERMIT J/ _- 9!1t11.1)d2 DATE VALUATION S t2,061)LOT TRACT �i � 4 Q ADDRESS 78 -732 SM -NA COURT APN - - OWNER CONTRACTOR / DESIGNER / ENGINEER 1;.'4?HtI-,' MNCOU'l11I. VA.'A.EY nr,C)L, & SPA. 78.732• SIENA. COURT 47410 E PALM CANYON D.R. # 116 1.A QUINTA CA 92253 PALM SPR.1NCYS CA. 92264 (7680)'778-3939 CJ3l.# 2565 USE OF PERMIT Yt.)1JI,,, AN 8:1/1. R. SPA I-100 ./S,18A. ALAREWMA�tt�,l.�►"R�3 %iAUL BE IN Kr M IPLA.S tit. + ll�lti?2EG I'1C1N. � pp - 12 1999 001.9124,131©R. , A .12,000.00 IS aP' l l Y MO ! 1�. a ED C011r 171N 11NIZU. fl i Of, \..Gt'VSAMIC l ION 1210141911M) 11'EUMF F CC SUMMARY Y PLAN CHECK PEE 101-000-439--318 587.7- (X)W,%TjRJK rllO I r1iT 101-.(301(1-419-000 N93MAN110AL. FM -- IO, 101-000-421-000 1+.1.:K''TRICA1, VEE .- I2i.:K)L 10.1-000-422V-000 PLUml ltl'i"'I 11c _- iii: o)� 101-W-419-000 23. ti r(YrAJ, C°ONS`TRIJ T_I,ON AND F2[.,AN C14ECK S;l.ft 75 11Ira�S, PRE-11t11D HLIE's $0.00 `!°i)'E:i"i;., PERM IT Si'CKs 'iil) E NOW RECEIPT DATE 8Y y DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans 0.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: a � 1611 ; t t S i J- I u� � 6 -�;rte►- . VALLEY POOL & SPA .. DESIGN do CONSTRUCTION 4741C E.Pain; Canyon, Ste 114 p �� � � Pahm Spdngs, CR. �1r' -1 s e:i a 4 �BUILOING & S.,,"UPETY DEPARTMENT CON NT O, ,ALLY ACCEPTED FOR GONSI 'ON SUBJECT TO INSTALLATION AS PER AND ALL APPLICABLE CODES 1-1-99 BY i , - .� - cook 7s�3z siENIA CITY OF LA QUINTA SUB -CONTRACTOR LIST os ADiDiIES$ FEMW N imm %CA bl �bt'L_ owfllElt_LIDREN UM MV wtt_ffBt VALLEY POOL SPA Only paraona sppearinp on this fist a dw* wrglotrM• so wrtha nd a ,work n this job. Any OharHpas to th's list swat ba apprwsd by the end" ft DWialon pdw to tornaw w wait of wait. Fa"* to comply will result in a wtoo~ of wart wwlor the voidance I bwidino owmit. For uch appkAbb trade all Mornown r" watad batwv must be o0rnpMtad b1l 'on Fila• is not an accaptalbla rarponss• cbsd f "M tJlowi v wew ftr- oss. Cwwfw" wa tMmv s m*w Kw trrs Lk"M IAMMW MO. Ow pq- A. IL G4P bas=d laxftd d 464- sam. f.M cascawo flwran v�whtl b Rl�ad Iwdud bultda0 -sa >'tlsso craa99 6jez' WcN 305(002 -1 ...1 oo:. 81lo I oe : of A 79301 A r31M OD 3 17-05 1/1 33-4 1/21 ■ — eaws.w rM.A. Loxnewo11Xtt:ttl -"TtueoPOOL COOP 0001Cgi?Ewsl AISiEACONC1M FRAHM" stflucf. sTM ic•1111 ■� ,: � � � it •:. � ���;"" MANWAtl wap � PLUMING W -M GATTU OMMOORP LA11t, PUM" i11CJ6) GROINS POOL PLASTERN6 MMALL K♦1 HVAC 1000 BAMWAL 00.101 GATTUSD POOL MOP rHDorMlo 044 SHOT ATAL W,4A NDaws fC-,fl O1A1M rO 1i1 sm",MIC.0 MwAOE Ow. OCA .Alla" "31 �CAMNKM$ RIrCND IC -1711 LA.IO.t:A..Ow iC,tM POOL W4M J 6 L GkMFE C-41 I If cbsd f "M tJlowi v wew ftr- oss. Cwwfw" wa tMmv s m*w Kw trrs Lk"M IAMMW MO. Ow pq- A. IL G4P bas=d laxftd d 464- sam. f.M cascawo flwran v�whtl b Rl�ad Iwdud bultda0 -sa >'tlsso craa99 6jez' WcN 305(002 -1 ...1 oo:. 81lo I oe : of A 79301 A r31M OD 3 17-05 1/1 33-4 1/21 ■ — • 1. .� •.:� ' �� ■� ,: � � � it •:. � ���;"" � i��i■ ��■■■i ice■ �r�r