9808-185 (RPL)LICENSED CONTRACTOR DECLARATION
%J 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
Professionals Code, and my License Is In full tofbe Arid AffeCl---
License Lic. Class Exp. Date
aD to Signature of Cont ac O
V
OWNER -BUILDER DECLA ATION
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 Policy No.
STAT`: FUND 1344032 -AS
(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 9f Section 3700 of the Labor
Code,rl sall {f&Aith comply with those provisions.
FJate:�' A � � i � IM Applicant ' � �t by
Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal penllties 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 madeto 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 cancellatiomr-
Vt
I certify that I have read this appli'c`ation and state that the above information ,s
correct. I agree to comply with all and State laws relating t ilding
construction, and hereby authgp a Fntatives of this City to ,
the above-mentioned property fii inpurposes.
ignature (OwnedAgent) Date
BUILDING PERMIT PERMIT# CONTROL
41I:3.1�
DATE , VALUATION '21 LOT jL TRACT 7583
CCC/
JOB SITE
ADDRESS ^Z55 SSUNBR }OK i..ANE
APN
- ^
OWNER
CONTRACTOR/DESIGNER/ENGINEER
HEIDI °PF't1'-FER
VAN4CIX POOLS COArS'f'1tf.It;TION
45-253 SUN'i3fiti?OKLANl
33.300 fw.VENIDA RAA IREZ
LA QLANI TA CA 92253
I.A. QUIN"T'A CA 91.253
(760) 50 s^3 55 CHIN' 21.993
USE OF PERMIT
POOL 11.IVf VOR ""PA
i'GGiirSP4 SHALL M.I'iv,AT Pr<Z-PLAS R
INSP1±:C°1`iON.
POOL ANDICAR SPA 21,000.00 I.S
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v
P
CO,'S . Of t'�N:'�'�:LTTi�" ONN
21F:Ii.>tt-�3i:
y, gggg �,rg SUMMARY zp g }E.51'T14'IL�TED
IT
PLAN CRECK H -l-, 101-000^439-318 5140.40
CONISTR I K1110N R -Y s01-(it1f3 41iz-t?t7Q $2t(0no
Afi€ CITANNICAL FEE -- YK?OL 101-0001-421-000 $24.4
ELECTRICAL FU -- POOL 101.X.420-000 $45.W
s�-419-0(YJ
I}l (1ME3:fT!Ct FI -- FK:Y)"L 101-
b
ST l �=iFi7:�s t C' i3c 'i tf "1T T'd Aiv11 ' , t� C;fTC;('!
$adz A0
LE'SS PRE -PAID FEES14
/
'. O cid. PERMIT SEMS DUE NOW
$452.40
01,
998
A
C/JA17DATE
BY
DATE FINALED
INSPECTOR
N J N
'r : e rr 0
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
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
3�
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
r
Final
Utility Notice (Perm)
COMMENTS:
.vr c. -Y., 75 To /o Z_