9710-163 (RPL)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Q apter 9 Jpommencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
Z) M License # Lic. Class Exp. Date
'-- 0U -)LU �/ a ii i% C-_53
oZ r ,/Date .Signature of Contractor
co O %
J U � OWNER -BUILDER DECLARATIO '
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
Z ( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
L
N Date Signature of Owner
ON
rn
d Z WORKER'S COMPENSATION DECLARATION
Nt p tr I hereby affirm under penalty of perjury one of the following declarations:
Lo r � 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 I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carrier Policy No.
ob O S'1'ei E N'UNNO 1061487-47
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 the workers' compensation provisions of Section 3700 of the Labor
Code, I shairforth 'witlp comply with those,provisions.
Date:r`� 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. e
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 application 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)" *wR Date
BUILDING PERMIT PERM'T�ry,�,�� CONTROL#
6164
DATE t VALUATION $' 1 x 00 LOT TRACT .
,~,40
1 l�
JOB SIT
ADDRES t3nJ SV1�.6�O1►,
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1NCO MONIES CORP.
DATE PALN1 ENTERPRISES
1282 W. ARROW" RWY
74-818 VE LIE WAY #6
UPLAND .Ca 91785
PA.L10 DESERT C.A. 922M
(70)34&2504 CHL# 18F1i3
USE OF PERMIT '
PPL
POOL AND SPA ONLY
POOL AINDiOk SPA 12,0W.00 i's
ESTIMATED CV8T OE CONS7'Ikl,CfION .
►x,titfl7.a�ti
PERMIT FEE SUMMARY
PLAN CHECK M' 10.1.000-139.318 $87.73
CO YSTRUCtION FEE 101-000-413-000 $135.00
MECHANICAL FEE -= POOL 101 -000 -471 -WO $24.W
FI.EG"I12fCA1, FEE -- POOL 101.-000-120-000 $45.00
PLUt#f8 NG FEE -- POOL 101-000-419-000 $VA0
r
Aw -TOT.A,L CONSTItucn-ON AND PLAN CRECIs
.�•! 1f.75
LESS Pk):-YA_1D Vf3ES
Sti,s>s3
a
OCT 31 1997 TOTAL PERMIT FEES DUE NOW
S319.7.5
,1
'1 Ty 0p;
RECEIPT
DATE
BY
D F LED 1
INSPECTOR
1 7
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Sit Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Zz
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Fin, I
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
407
Sewer Connection
Encapsulation
..
Gas Piping
Gas Test
Appliances
Final
7i&7
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
v 11nA�� ��
a�
V
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F
2
Ti am
CITY OLA OUINTA
BUILDING & SAFETY DEPARTMENT
CONDITIONAL(Y
ACCEPTE;'D FOR CONSTRUCTION
SUBJECT/TO INSTALLATION AS PER
I.CGr;1tG �vI Il
�. AND ALL APPLICABLE CODES
POOL AREA SCALE 1/8' V 1 d-3 I c1 BY .�—
PLOT PIAN -NO -SCALE
INC
POOL SIZE DEPTH TO PER SO. FT. ❑INCLUDED
TEMPL. NO. �- FILTER NO. H A' j, r� I �' �� yOTE: SHALLOW END ... LADDER .... • • ❑
J _ cr ` DEEP END DIG ...... SLIDE ❑
SHAPE _ NO. RETURN LINES L' • '� P -TRAP .......... ❑ UGHT IN SPA I O x. [$
� [� W) / .BACKWASH LINE .... ❑ SPA (0! �)
ACCESS -ir=- Ff. _FENCE + l L �,7 30 Q �ti L ->�`-L4 ❑ ^!�LORINAT
MOTOR , I "' PUivP .+ HP I GRADING ......... ❑ ROPE RINGS ... ❑
a�-"IU+� R :•L1 h •. t HEATER �0O CQj • @ NWNT. KIT .....
UGHT_ANTISYPHONYES;h�CI �� f� �`' U
' i._ GUNfTEINS ........
ELECTRICALFT. BONDING YES �1• • • • • • ❑
BOARD ......... ❑ OTHER ........ ❑
GAS e
41FT. TILE fl,?, COPING N0. eA.AJr-
LOT— / OWNER �
DATE PALM ENTERPRISES --� � � / ,pBApDRESS7?
POOUSPA CONSTRUCTION COMPANY TRACT CRY MAP N0:
619-325-2187 JOB PHONR/ j/ - S. PHONE,
SALESMAN 0 -PLAN NO.�Jv JOBNO.-4-W
CITY LIC. NO. CONTRACTOR NO. C53-591925
4
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