0003-002 (RPL)LICENSED. CONTRACTOR DECLARATION
�hprphy affirm undp.r pPnRlty of nerjury 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 force and effect.
License # Lic. Class Exp. Date
�te3'
C53 02t2812LX„Dl' ��} Signature of Contractor ! J
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.
() 1 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 A yM �i.7S 7 Policy No.
i'�'aA\I4l+:1PY`,s.i.I{^hri� 'i`a�i21 00.3 7 971.
(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
sweet to the workers' compensation provisions of Section 3700 of the Labor
Code, l,s all forthwith comply with those p ovisie S.
A u 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 Quanta, 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 cessatlon 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 iglipec `o purposes.
"Signature (Owner/Agent) Date
t
BUILDING PERMIT PERMTW.I-002
DATE 0,3I011I20VALUATION Jt �.'I. IEO,{}� 1 LOT ` TRACT 2.19954
JOB SITE 45-515 SU NBROOK LAND
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
r�[;liT"j'�1U[tr'rp�lt�J[:[ t t"t'iARAA[T�s["a"S7Ir
1... S,.li. ),\ ! \..1� 11 !•1.0 ,-..1lY..iY}.J♦+L.!!}-.41
kl[Irk) 1)1V>a LVIWI) S'
♦,\l�v.�l:.lt.i ! ,.JVlw�)
1535 Sia. "D" SIR E r, SIR Y200
44028 EL1:HORN Tit.
SAN .8jt1tNARWING' CA 92408
PALM DESS l' CA 92260
l7fip�34O-Si21 CBL# 160
USE OF PERMIT
KX)L ANDiOR StPA
POCIL AND ,PA QNL”%7 - MLARAISMAkR ERS SARAII.L AE 1N i'LAC E .r3#
P'ltta-t�LAS't'r.'i( I.t�lat'l°.:'S`d(.st�1
POOL ANDPOR SPA 17,'_+00.00 LS
3 t� -ED COST O °4.L1'�i-STRf ICTION
,1 �s�YiU.aV
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P
PLAN l:'.H-E K. FEE f 01-()OU-d3u-3I1i 31'12.8ti
"'f9r�3NS'[Ri{}ft"nr'�I.fy(�Nt H #/(fit4-li�l((�N(1�-4q 151-i(lf{l}f(? Iouofir)
/�Y
iYii:C1'J lA *V1CAi, ),'ti.%i -^ fy •\:I.l. I0'A_00 7-121'. A.^V{/\'
E'LiECIRLICA.L FJI'i-- POOL Joi-i 0 -420 -ow 345.V11
t'LUtvt4�ff�f i i f F -- N�xtL 1.01 -000 -4I9 -M $:T(KI
k,4
St, 1-1,Xyr 1 t, C nN C"5 kf IC"1'j0N ANfry►��1111-A Ni iT-7yrx,,
$,107 Its
1 ,1
RECEIPT
DATE
BY t
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
Vents
Insulation
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
- Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Zy • t 1 - 00
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
(d
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
6 ell _0
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
i �r so•••.. ""`I d to . wr't- d� � w �
1
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)
w
P/L
I
S
.. .... -i AN
a; +. ANY C'
T BE HONORED
Nli 0 D! C;
J 10 N S'V-11 i L L NST
UNLESS ACCOMPANIED BY A SIGNED
CHANGE ORDER, PRIOR TO ANY WORK BEING
DONE.
DATE
x
A REINSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB. CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
CITYI
Ty OF'A
� Q
U
INT
A
/L BUILDING & SAFETY DEP
T
.
AppROVED
FOR CONSTRUCTION
DATE BY
(760) 340-5521
PALM DESERT) CA
GENERAL SPECIFICATIONS
)OL SIZE
III
IN
ACCESS
DECKING
RAISED BOND IEAM
SCALE
SPA SPECIFICATIONS
SIZE 7.
SHAPE CU51-om
JETS
RAISED
BENCHES
BOOSTER
t2PF-W r-AAAIL-Y
L-01- 25 - 12PF-AM HOMF-5
L-A QUINTA, CA
APPROVED BY: COPY'
THIS DRAWING REMAINS THE PROPERTY OF SUNRISE
POOLS. EPRODUCTION OR UNAU
WITHOUTRPERMISSION IS PROHIBITED.THORIZED USE