9710-165 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
/ 690775 C•51 C --21--M. 198
Date�• Signature of Contractor
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.
(♦) 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 carries & policy no. are:
Cartier Policy No.
STATE FUND 1061487-97
(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
Pode, I sh11 fort 4it comply with those provisions. ;
Date: /�SApplicant %+ -' --
Warning: Failure to secure Worki§ srCompensation coverage i unlawful and
shall subject an employer to criminal penalties and,.civll 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 propertinspection purposes..
ignature (Owner/Agent) �'° Dated, T%
E 3 j
BUILDINGPERMIT PERMIT# CONTROL#.
DATE % VALUATION sq,so0 00 LOT TRACT
`1-7
JOB SITE
ADDRESSi'`Ilel,R�fs � SiUNBROOK ADDRESS"
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INCO HOMES CORP.
DATE PALM ENTERPRISES
1282 W. ARROW HWY
74-818 VEL1F WAY #0
UPLAND CA 91785
PAL&I DESEWr CA 92260
(760)141 -2504 t_ OL9 18&
USE OF PERMIT
POOL
Pt7e)i, ONLY
P001, AND/OR SPH 9.5W.00 LS
ESTUNIXfED COST OF CONSTRUCT ION
9,51will
FERM.fT FEE SUAIRUARY
MECHANICAL FFb -- POOL 1.01-000-421.0W S :.00
ELECTRICAL FEE -- POOL 101-000-420-000 $45.00
PLLINIBING FEE -- POOL 101-000-419-000 $27.00
PLAN CHS FII 101-000-439-318 $75.05
C`ONS'1RUCrION FTE 101-01W418-000 $117,01
F
U�d
B-WrAL: CONgfRUCT10N .AND PUNN CHECK
3:wa.o
LESS PRE -PAID 111315
! (M)(1
OCT 31 1997
TOTAL PERMIT FEES DUE NOW
5289.05
RECEIPT
DATE
I BY/
DTE F11, D
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
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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 AA
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 7
Gas Piping
Gas Test
Appliances
Final Ig .31le ;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)
7N "' �-x
it
3
Ilen
1� O
V"
IN
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'KC
v rl-T 7 -
CITY OF, LA LA NTA
YDEPARTMENT
BUILDING & SAN'
45.
i 4-
SUBJECT TO INSTAU N"IC' ` AZ)
AND ALL APPLICABL CODES
POOL AREA SCALE 1/8" l' -
BY
PLOT PLAN -NO -SCALE
POOL SIZE / -e--)% 50 DEPTH -75 TO 5 -5 PER SO. FT. L,2 L)
TEMPL. NO. Z- FILTER NO. NOTE:
k7,
SHAPE NO. RETURN LINES
ACCESS LCZ FT. FENCE —41:11L�
IVIOTOR�PLiiviz HP
LIGHT 1v9Z•' ANTISYPHONYES
ELECTRICAL -a FT. BONDING YES
GAS�FT.TILE ol ff'COPINGNO—�
LOT OWNER
JOB ADDRESS
TRACT
CITY MAP NO.'
JOB PHO S. PHONE
SALESMAN1� P �:Z�
JOB NO.
0INCLUDED
SHALLOW END
..... 0
LADDER ......
0
DEEP ENO DIG ......
0
SLIDE .......
0
P -TRAP ...........
0
LIGHT IN SPA ...
0
BACKWASH LINE
.... 0
SPA
0
FILL LINE .........
0
.........
Cul-'ORINATOR
GRADING ......
0
ROPE RINGS ...
0
HEATER .........
0
IVIAINT. KIT .....
0
GLINITE INSP .......
0
TREES .......
0
BOARD ..........
0
OTHER .
0
DATE PALM ENTERPRISES
POOL/SPA CONSTRUCTION COMPANY
619-325-2187
CITY LIC. NO. CONTRACTOR NO. C53-591925