9710-162 (RPL)LICENSED CONTRACTOR DECLARATION
U) I here%y affirm 'under penalty of perjury that I am licensed under provisions of
H 6hapter 9'(commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) co License # Lic. Class Exp. Date
r.- d U.)
6 i98
�y ��
o 53 C
Z ti /Date f G Signature of Contractor v"' =^®
to0r�
J U C) OWNER -BUILDER DE RATION
LLI LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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).
( ) 1, 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
N Date Signature of Owner
ON
Cn
z
WORKER'S COMPENSATION DECLARATION
C:) :E Z I hereby affirm under penalty of perjury one of the following declarations:
U-) � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O _ Q performance of the work for which this permit is issued.
m Q U Q6 I have and will maintain workers' compensation insurance, as required by
O U Q S tion 3700 of the Labor Code, for the performance of the work for which this
rn permit is issued. My workers' compensation insurance carrier & policy no. are:
'IT Z Carrier Policy No.
cb =
a S'. NTE F= 1061487-97
J (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 thefworke�rs' compensation „provisions of Section 3700 of the Labor
Code, I shall forthwith.mply with'those provisio S. -
�Date: /%J applicant 't!�
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 \1
construction, and hereby authorize.representatives of this City to enter upon'
the/above-mentioned pro erty,for�inspe�ction purposes. ! j4
VS gnature (Owner/Agent) --�"'"E'' ' ,y Date f ✓%/
BUILDING PERMIT PERMIT# °°NTR°`""
))
DATE J VALUATION LOT 9710-162 TRACT
6163
' 7
19.500.00
JOB SITE
APN
ADDRESS
78-81 5 8UNBRO(YK
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ENCO HOINIES CORP,
DA'T'E PALM ENTERPRISES
125.2 W AREtOW H'W"Y
74-818 VF LIE WAY #6
UPLAND CA 71735
PALM DESERT CA 922.60
(760346-2504 CRL# Im
USE OF PERMIT
t
POOL OM Y
POOL ANDIOR SPA 9,500.00 L3
ESTIMATED COST OF CONS TRUC110IV
S1,Stftl.i3ti
PERMIT FEE SUMMARY
PLAN CHECK FEE 101-000-439.318
rrZ1H9•rAVr_111(:1NW01Z tOi-"4494M ss:r.i�tt
ft1A.:41/,erhA1QP►1. KPi;M •• 101-49A)-4hl-4KRO 47Pt.lhU
ELI-_(. Mt"IKPUAL t.... t't�!1. ili!A"j-420-LIOU �5.(K►
.
PI.t)f�AHN(t I1+_*H - WAN. 1014)00z-fl9-(><!ii $' 7oi
F
r
'Zf If4•`f7if'Af•
_ VONC'11VI tC"f'InN ANIS E ;thj f l jf [ .r
x?tj!),315
t __ I..I;i?.-PFiUD i I~ 5:;
VI,itU
OCT 2 9 1997 TOTAL PERMIT FEVS DUC NOW
$289.05
f O!zu
5
RECEIPT
DATE
BY '
DATE FI ALED
INSPECTOR
01
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 Wali 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
CV
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
yl
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
L
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
F'tdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
y
-44
�, f•;. O `
�45
POOL AREA SCALE 1/8° 1'
PLOT PLAN -NO -SCALE
POOL SIZEDEPTH - ' TO
TEMPL. NO. FILTER NO. rzlvo
SHAPE � NO. RETURN LINES
ACCESS �_� FT. FENCE altj
MOTOR �- iiFuiviF ' HP
LIGHT T )bi-ANTISYPH &YES
ELECTRICAL FT. BONDING YES
GAS FT. TILE qjg COPING NO.
CITY OF LA OU CITTA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CON S•iRUCTION
SUBJECT TO INSTALnON AS PER
AND ALL APPLICABLE CODES
�. BY
PER SO. FT.
NOTE:
p�•y iV� rt�r��
DATE PALM" SNOOTERPRISES
POOL/SPA CONSTRUCTION COMPANY
619-325-2187
CITY UC. NO. CONTRACTOR NO. C53-591925
❑ INCLUDED
SHALLOW END .....
❑
LADDER ......
❑
DEEP END DIG ......
❑
SLIDE .......
❑
P -TRAP ..........
❑
LIGHT IN SPA
... ❑
BACKWASH UNE
.... ❑
SPA ........
❑
FILL LINE .........
❑
^-LORINATOR
GRADING .........
❑
ROPE RINGS
... ❑
HEATER .........
❑
MAINT. KIT .....
❑
GUNITE INSP .......
❑
TREES .......
❑
BOARD ..........
❑
OTHER ........ ❑
LOT OWNER
�; JOB ADDRESS71 �,J(,�/V
TRACT „L.y CITY 4;0 MAP NO.'—
SALESMAN
O:SALESMAN V�..
PLAN NO .-!�'_3 1- JOB PHONE�BUS. PHONE 777-77
JOB NO.
C
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