0105-326 (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.,D vision 3 of the Business and
Professionals Code, and my License is in full force :and effect.
License # Lic. Class ' Exp. Date
556236 C53''
Date Signature of Contractor Al l )
OWNER-BUIL1DER DECLA AT,IOQN f`
•n'"11:;;, .
I hereby affirunder penalty of perjury that I am a empt 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
( ) 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 &�.�",I1PT Policy No.
�ta
(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, nd 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./" f
Date: ' ° Applicant 11 Mev
"" Warning: Failure to secure Workers' Compeos�tion coverage is unlawful and
shall subject an employer to cnmmel penalties "'nd 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 thi"s'ICity to enter upon
the above mentionedproperty for Inspection purposes.f
Signature (Owner/Agent) - -�� �r �t nDate/ f J
.w.n.."""...�,. __ _.. •.i.^.•w.+ww........: orf:-:...: ?i -:l n_. _..... � . .. _ •y. __ _ _.... -
BUILDING PERMIT PERMIT#
DATE �! VALUATION LOT 01.03-326 TRACT
//
�t
JOB SITE f �'
APN
ADDRESS
3-05 MIMS COU M%
OWNER
CONTRACTOR/DESIGNER/EN (NEER
Dfix
4? -635 MAIM US C'<:riW
6.2 C'.�70LEIVW 8 AW,
LAQIJ•[WA CA 92253
IRMO CA 92255
r36�9)27:�� f•tT3 C'B • i 604
USE OF PERMIT
POOL AISIDADR OPA
POOLAHL AWZM,%f'iI�,I'�dtIZRS SHAJ-1, UP, P14 PLAC,f; AT PP.& Pi,.A STE.R
INSPY?M10W, POOL &QUIPTa3UT ENCLOSURE NOT dNCEUDRD.
POOL ANDIOR SPA too, 09 D
.W
EN TED COSM Off" COMMiTC;"A'°100
1%100=
PLAN "iCit7i101-1?0-439-318 1T..
CONSTReUC71ON ME _101-000-418.000 $iaT1?
fpS1Qy
�E�C;��!11�fyt)2�+ir�CqAp Yt.�FRE •- POOL 101O00-423-�3v
y&��
9i/Sl+Cil.a b CJCA•! L t'MS °P POL.I�iM 101-000420-000
PIdD'MIrRIG PRS -• POOL 101-.000-419-000
•t
:' . `' � X001
SUN
Y 0 . LA OUINTA
5X78.1.3
t
IJ TOTAL PERW ' JITZ8 DUE NOW
$318,15
RECEIPT
DATEry{ /
BY
DATE FINALED,
INSPECTOR
F. ,� / �' ..�"
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
I D
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
Sewer Lateral
Sewer Connection
O.K. for Finish Plaster
Pool Cover
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:
CITY OF LA OUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE D l - B —
GENERAL SPECIFICATIONS
IOL SIZE 15 ^ 3 O
IOL AREA
IOL PERIMETER `
IaA'4I):41111I101W�ZOZO]
SPA SPECIFICATIONS
SIZE 7 '
SHAPE C U S T O M
T (
- -
JETS 4
/ �jhu ^
RAISED
BENCHES
BOOSTER
- DON JOHN50N
;.43e b3S
L AOUINTA CA 9225b
-•
APPROVED BY:
(760) 2756409
THIS DRAWING REMAINS THE PROPERTY OF SUNRISE
PALM DESERT, CA
POOLS. REPRODUCTION OR USE
TED.
WITHOUT PERMISSION S PROHIBITED.