9712-073 (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
Professioi7als•06d-f'and my License is in full force and effect.
License # Lic. Class Exp. Date
658496 - C5 3
Date - Signature of Contractor
OWNER -BUILDER DECLARATION
11130198
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.
(X) 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:
Carver Policy No.
SI ATE 1: UM7 1341032-47
(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: 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.
/Signature (Owner/Agent) Date
PERMIT PERMIT'# CONTROL#
BUILDING
DATE VALUATION LOT! 9712-071 TRACT ; 6484
;Il16,301D,00
JOB SITE. APN
ADDRESS
44-215 SWEET HITSH LANE 609-081-029
OWNER CONTRACTOR/DESIGNER/ENGINEER
DOUGLAS k & SANE"1'..A ADAIV1S FAMILY .POOLS CO S1'It"UCi1('_)N
'44215 SAtFiE"1' BU5I4 LN 33300 A.V'ENIDA 11_AMIREZ7
L.A. QUiNTA. CA 922-53 LA QUiNTA CA 92253
13h0}S�b3fr5� CBL# 2893
t
USE OF PERMIT �
P001.
?ttOi. d13+ILi SPA C1v1Y DAI
POOL AM/OP. SPA
DEC t 7 1997
16.5t10.00 LS
CITYOF
m
M IMAIEID COST OF CONS'.C1 V110N
PERMIT FEE SUMMARY
PLAN CHF -CK FL -E
101.000-439-315
CONS` RUCTION M
IO1-000-418-000
118(i.(Hl
IVIECHANiCAL FFA — POOL
f0f -000 421-000
HLECrAICAL FM -- P001,
101-000-420-000
$45.00
PLUNIBING HE -- POOL
101-000-419-000
$27.00
QUANTA „
4
16,500m
SUB -TOTAL CONSTRUCTION RIND PLAN CHECK $393,N)
LESS M -PAID FIX, S $0.00
TOTAL PERMIT FEES DUE NOXV 5393.00
RECEIPT DATEBY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slate 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
Underground Plbg. Test
Q,
Final
Gas Piping
y
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
/Z—
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
Ublity Notice (Penn)
COMMENTS:
i Lic- 465899,6 `
�•} ,' ..i 3 ri'y�- t -�4. X tt, i'' f J t}�'t. }, y 7 } .••,t
•- - r :t - ,.y.. �'. tit.,rYt_ 7• t1 3:rL Y{:i�njr.T;}`,{#:i
TN���`\. -78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253FAX (760) '777-7101
�- .TDD (760) 777-1227' T
May 18'1999
•
Douglas R & Janet.A Adams '
44-215 Sweetbush Lane `
La Quinta, CA."
A. 92253. ;
RE: Pool & Spa Permit 9712-073
Dear Mr. & Mrs. Adams r-
jThe purpose of this letter is to infoim you that your Pool+& Spa Permit 9712 073; for the,,' -,'.,,.`'
1 1,i, �.5..t .: Y ` ' with 1994 UBC section 106:4.4 A
project at 44=215 Sweetbush Lane,.has expired..In accordance `
no further'work may be performed until a new .permit has been issued: t `' ` ' t ' #
i
Please contact Daniel P. Crawford'Jr.; Building Inspector I, at (760) 777-7012 to obtain any 7
information you need'regarding a new permit and/or any, required inspections. Should you
choose notto complete the project; we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile. ,
3) Action filed with Contractor State License Board. -Optional if OwnerBuilder.
Please contact us at your earliest convenience prior to 10 working days to resolve this'. issue,, and
for any questions you may have. -
- i_
Sincerely, t
f
Mark Harold.
Building & Safety Manager ,
aniel P. rawf rd
Building Inspector I
cc: file