0212-109 (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 Busines_p and
Professionals Code, and my License is in full force and effect.Z.Ie,
License # Lic. Class E' 2,10015 C-:53I�X4 /�fDate��t" '� Si nature 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:
( ) 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).
( ) 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 amlyt, Policy No
(This section need not be completed if the permit valuation is for $100.00 or less).
(w) I certify that in the performance of the work for which this permit is issued,
0shall not employ any person in any, anner so as to become subject to the
workers' compensation laws of Calif ryia, and agree that if, I should become
subject to the workers' compensation provisiodns o Section 3700 of the Labor
Code, I shall forthwith comply yvith thd�Siprov)signsa�
Warning: Failure to secure Woikers' 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, indemnity
& 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 comply4th alll City, a�,State laws relating to the building
construction, and hereby authoriz?,,re fesentatives of this City to enter upon
the above mentio propert`yrfo rinsp2ctI - purposes.
Signature (Owner'yAgen"t),,!�.�"w,,
a I :
SU166ING PERM4T --w_-W-; PERMIT#
DATE , r� VALUATION LOT �_� TRACT
JOB SITE
ADDRESS 8-01 IML M, 0 ROCK Tk7RR
APN r
'OWNER...,
CONTRACTOR / DESIGNER / EN (NEER
78-69,1
4.7,1 1 C. E, P414 CVNN W, D1 OVA 6
LA QVJN A CA 92253
PALM �t�.WKSS CA78-39,79
Yg926
7Z'4 2,565
USE OF PERMIT
PC)OL A1, INCT1, S0A
WA7"IM FF.1kTUR 'M BE AODUI TO MIS'TMI.3 POOL,
PiJO&J1,11DJOR NPS � DCQ.gIt ,t
�+X 7FtiCAL FEED - POOL 101 -WO -42.0-000 3s4S.11ii
PLUMtB1'1.1O VER - POOL 101-000,410-000 $2 AKI
S
'�iITA- "CAL �,`C�1,+Y!'�`%'1y".1:1`t .'`�"fO .AND PLAN CHEIC"9
$322.00
��
A\ 1C"M PRL -PAID 1>
$0,100
D*CAAB
8:b ��9 RST ,�J dJ 5719: .LF1Y'YY
ty.324.00
DEC 17 2002,
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE j
BY�c_.��__�
"�-..�
DA I ED
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
OX 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
�a e.Equipment
Location
Underground Electric
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
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:
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FROM : MARY CASTORENA
PHONE NO. : 7607725850
CITY OF LA QUANTA
SUB -LIST
Dec. 16 2002 06*3BPM P2 O /
CONTRACTOR VALLEY POOL & SPA ADDAES: 4741C E.•PALM CANYON DR #116.
OWNER LEEN JOB ADDRESS 78691 TALKING
ROCK TURN
This for shall be OQSted oR the job with the Building !no ll tion Ganl at ell times in a consnigL+OLt nlace-
It is the responsibility of the General Contractor or the OwnerBuilder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any chanl)es to this fist must be approved the
City of La Quinta Department of Building & Safety lri9.i: to work being performed by a changed sub-
contractor. Failure to comply will result irf.'a stoppage of work andhrr'the voidance of building permit.
TRADE
'SUB=CONTRACTOR'S'
NARAE"
TYPE:OF8'
LICENSE.. . ;
TA7Er;'.;,w',;,:':.;: ;Mf4RKER'.S:=::...:'
L`IiNTRtkGTOR'';S'. `.+;'COMP
>i7MBEIt-:ON
<Slldmfts:
NAMED' :.:
FILE:
I ICEN5E:.
GRADE/
EXCAVATE
GATTUSO POOL
A/C -12
672850
6/30/03
ZENITH INS
Z044986401
3
816A
12/31/02
PIPELINES
C-34
CONCREM
FOUNDATIONS
TIDWELL CONCRETE
C-8
731006
1/31/03
CA INDEMNITY
N804Z3348
5/22/03
1978
7/14/03
ASPHALT
A
FRAMING
B
STEEL/
STRUCTURAL
C-51
MASONRY
ROBERT TAYLOR CO.
C-29
629176
PLUMBING
GATTUSO POOL
C-36
672850
816A
LATHING
C-26
DRYWALL
C-9
PLASTERING
CROWN POOL PLASTERING
C-36
427606
1154496-97
,403
t a
8/7/03
HVAC
C-20
ELECTRICAL
IGenenall
GATTUSO POOL
C-10
672850
816A
ROOFING
C-39
SHEET METAL
C-43
FLOORING
C-16
GLASS/
GLAZING
C-17
INSULATION
C-2
SEWAGE DISP.
C-42
PAINTING/
DECORATING
C-33
TILE
C-54
CABINETS/
INSTALLATION
C-6
FENCING
C-13
LANDSCAPING .
C-27
POOLS
C-53
OTHER
J & L
472187
g q
?/23/03