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9801-149 (RPL)LICENSED CONTRACTOR DECLARATION s s Thereby affirm under -penalty of perjury that I am licensed under provisions of F Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N W ' Professionals Code, and my License is in full force and effect. L'e O ch Lise # b Lic. Class Exp. Date r-- d L r W r-- X17 % + C'-?a'r 2 i } d w rr.�i0J9i oZ: Date ,r� f Signature of,Contracto_ r 0. J V 0 OWNER -BUILDER DECLARATION 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 Lproperty, 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). co () I am exempt under Section B&P.C. for this reason LO C\; 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. (tf 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' compehsation ihsurance carrier & policy no. are: Carrier Policy No. STATE PUNA w614#7-98 (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 shall forthwitth comply with_those.provisions. , f� ✓Date: f.7 Applican .��jj-9�'' Warning: Failure to secure Workers' Compensatio nrco�er gads 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 nulland 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 t above-mentioned property -for inspection purposes. !/Signature (Owner/Agent).�1�C%`� BUILDINGPERMIT PERMIT#°NTR°`# DATE j VALUATION - LOT �KOi-14g TRACT 7 D/l =!C $12,000.00 JOB SITE I ADDRESS 70-.940 ,SUNBROOK OWNER A. i�. AYALAISAVAGE 78-840 SUNAR©OK, LA,Qt4NTA USE OF PERMIT CA 9225:3 APN CONTRACTOR/DESIGNER/ENGINEER - DATE PALM ENTERPRISES 74818 VELIE WAY 96 ' -PALM DESERT CA 92.260 (760)346- 504. CAL# 1888 POOL & SPA C NLlr,. POOL ALARM/BARRMR, SHALL EF, INST.M: LRD AN1D OPERATIONAL AT ENCAP/PRE-PLASTER. INSPECTTON POOL AMD/OR SPA 12,000,00 LS FNTIMATED COST OF CONST ItUCfION PERIAIT FEE SiJl111t 1A.f V PLANCREC FEE i(1!-OOIt=X43 3{8 $87,75 CONSTRUCTION FEE tol-OW-41&000 $135.00 1WP.,c�.'I✓AMCAl(.FEE --:POOL 101-000-421.000 $24,00 ELW:-TRICALFE8—POOL 101-000-42.0-W $45.00 P1;tf1 RING FEE _- POOL 101-000-4J9-000 $27.00 SUB-TarAL CONSTRUCTION AND PLAN. CHECK LESS PKK -PAID FEE S TOTAL PERMIT FEES IiUE NOW .i2,dl00.If0. - RECEIPT DATE BY I — DATA B ALED INSPECTOR 'ii5, . INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR Y 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 POOLS - SPAS BLOCKWALL APPROVALS steel 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 a COMMENTS: .q.t.,Aieens 'tel Ko 5o8;s rrL a-a?ANOcoCS ` 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) �9�7�`/�'' ,I • � ,Tim, � - {` �,i r � a 4 , '.' A. _� ,•. \ � �• .• , p , fly` F --�_ ,A -� TIENT Qp�� 'ACCEPTED t"v R c pt�.: "F-; f<� � ��C3�•� � AND ALL APPLICABLE 'CQ ES 3 zIq POOL AREA SCALE 1/8"l' PLOT PLAN -NO -SCALE ' POOL SIZE DEPTH TO - PER SO. FT. 2 ❑INCLUDED TEMPL. NO. i� FILTER NO. //21 Vk-AW I7S NOTE; SHALLOW END ❑ LADDER :..... ❑ y TL/ vu'iF�� SHAPE, NO. RETURN LINES 3'�o ZeQ CdA�� n�L DEEP END DIG ...... ❑ SLIDE ` . ❑ ",?puuD P -TRAP ❑ LIGHT INSPA ❑ .......... ... ACCESS iD FT. FENCE _/�%zfi/j) �P� BACKWASH UNE ' SPA ❑ .....❑ ........ MOTOR PUivc= HP ']/ :TFT �r . ' FILL LINE ......... El, ^!-. ORINATOR GRADING ..........: ❑ ROPE RINGS ❑ IV779- LIGHT ANTISYPH N YES ... �p HEATER r..... ., . ❑ MAINT. Krr ..... ❑ ' ELECTRICALcSy FT. BONDING YES r"' C GUNI TE INSP ..' ....: ❑ TREES ....... ❑ • GAS IFT.TILEAM COPING NO. C A"I BOARD ..........x: ❑ OTHER ........ ❑ VC9 _ - LL LOT / OWNER DATE PALM ENTERPRISES . JOB ADDRESS • rAl )C'0 � � °, - �- POOLISPA CONSTRUCTION COMPANY TRACT " -= a -�.-- U-"- - CITY MAP NO: y 619-325-2187 JOB PHONE ' BUS. PHONE SALESMAN PLAN NO . / ` • CITY -WC. NQ. CONTRACTOR NO. C53-591925 JOB NO. "