0201-168 (RPL)LICENSED CONTRACTOR DECLARATION
'I -hereby affirm under penalty of perjury that I am licensed under provisions
o
Chapter 9 (commencing with Section 7000) of Division 3 of the Business ay
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
03 VI C _ 6/30/03
Date ? t. 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 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:.
Carrier ,�2"Z r.I, Policy No: 1615M -W
(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 Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date:,, Applicant—
Warning:
pplicant 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 inspection purposes.
t
Signature (Owner/Agent)-9 -- Dates
ON
�---- BUILDING PERMIT PERMIT#
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DATE VALUATION LOT 0201-468 TRACT
JOB ITE55 —�(3S
APN
ADDRESS
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OWNER
CONTRACTOR/DESIGNER/EN (NEER
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Ofimuso :!?C7rJL .PlumBiwa; ATC
8-535'AJM1 92Y'WA
66I."A:2FRDe.-
iAQUITMA CR 922.13
RAL ,JYOIS''
CA. 922,(A ,(b
USE OF PERMIT
P001— 'I"?.fOR :4'%A.
k'001USPA.
iMPRCTIOW PO�OI. XQUIPM-KHT ENC[MlTrll? NOT 1Ni:LUDRID.
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IPFAWT IMER MIMA.'RY
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AilF.:CNdA.WC; AL Y&E --POOL 101.000-4211.000 524.09
( ELECTRICAL 111 wA POOL I M -WID- 2104.2L0
PLUMBING FEE -- }'0010,. 1ti3�-�atl-i} l ��UGfl X3`3.40
/IQ L! - 3
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JAN 2 5 2002
SUB-`X)T. ,C0XX.1TZtC``Y10. i`".0111ARfC`%Tt^,C
$?63 0
'LESS PRE-RAIDAMS
$0.00
RECEIPT
DATE
BY
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
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
Set Backs
Steel
Electric Bond
POOLS - SPAS
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
44-
yFinal
Final
Gas Piping
PLUMBING APPROVALS
Z
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
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:
01/22/2002 11:21 7607784920 GATTUSO POOL CORP
is
. m
Lmmm
A-1
CATTUSO POOL CORPORATION
967 FOUNK R0. o
PALM SPRINGS, r.A 92264 3- � 00
OFC (160)311-7592 FAX(760)778-4920
LICENSE # 672850 16
OF LA QUINTA
BUILDING & SAFETY DEPT, U
APPROVED
FOR CONSTRUCTION
I
I DATE '-as 0 Z -BY
2-
PAGE 02
4OF
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777.7153
Owner ]KAREN DALE
Contractor GATTUSO POOL CORPORATION
Permit Number 0201-168
POST ON JOB IN CONSPICUOUS PLACE
INMECTOR MAST SIGN ALL APPLICABLE SPACES
> .7 =53 TURNBERRY 'WAY I
JOgADDRESS{" I - -
POOL/SPA. ALARMS/BARRIERS SHALL BE IN
PLACE AT PRE -PLASTER INSPECTION. POOL
EQUIPMENT ENCLOSURE NOT CLUDED
TYPE OF INSPECTION DA INSP.
FOUNDATION d SETBACK
f FOOTING STEEL
GROUND PLUMBING
PRE-GUNITE '
DO NOT POUR CONCRETE UNTIL AL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
N14104
DO NOT FOUR CDNCRETE UNTILUALL ABO HAS BEEN SIGNED
ROUGH PLUMBING
ROUGH GAS d GAS TEST fy(
NFATOJr, A VFAIT. Air.
ROOF
BOND BEAM
O.K. TO WRA
GROUT C7 4'
PR
COVER NO"WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE A GATE
SEWER SEPTIC TAN
FINALE
FINAL GAS TEST
HEATING • A/C
HOUSE NUMBERS
TEMP POWER
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