9710-181 (RPL)LICENSED CONTRACTOR DECLARATION,
der
,,;heret,_, .4ffirm un 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
"�t Z
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:
( ) 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 (Seca 7044, Business & Professionals
Code).
!.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 the work for whic h 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 carrier & policy. no. .are:
Carrier Policy NO.'
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kit Vp.wl
I VIT r., *FUNT111,
(This section.need not be completed if the permit valuation is for,$1 00.00 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 forth�w'tlh C mply With thoself—OK-1slons:
plicant—f
Warnifig; Failure to secure Workersprag is ' CoKoensation cov unlawful and
shall subject an employer to crir� inal penalties and'civil fines Lip to $100,000, in
addition to the cost of compensation, damagd's`as provided for in -Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director -of Building and Safety
for a permit 'subject to 'the, conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made &'each person at
whoserequest and for whose benefit work is performed under or.purs , uant to
v
any permit issued as a result of this applicaton agrees t & shall, Aemnify
& hold harmless the City of La Quinta, its officers, agents and.employees.
2. Any -permit issued as a result of this application becomes null and void if
work is not commenced within. 180 days from date of •issuance ' of such
permit, or cessation of work for 180 days. will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and-Stat6 laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
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the -above-mentioned property for inspection purposes.
Signature (Owner/Agent) d = - Date
PERMIT#' CONTRCL#
BUILDING PERMIT
DATE VALUATION ., * 2.t1#0,#
gi LOT. TRACT 1V tai i 7�228�.
JOB SITE
ADDRESS APN
0%�j �fl6S UN �$IR
,,OWNER CONTRACTOR/DESIGNER/ENGINEER
,-r,147 P A I
.(,Ohio.
t 218 1 W.JVLrZ0WflW1V
UPLAND. CA ail IS,$ PAIJO mswr A 922,64)
qW)IIU-5. M4 MLO IM
USE OF PERMIT
Pt')C)'L
1�ool, lwb spk
T1111.1 ... 1* Wil -061.00 LOI
1KAX iv
flTrIMAT-1i".0 C09T OF CONS1 IN, Uc'llwl 10N,
PI.At4 CURCKPT-HE
C0NTR I Kr0N PER 101 -0O0 -4!9-W) 00
NIFCIDWrCAL M POOL ot-W41211-000
4v. 0 0
ELIX11TRI Clul T, rlEl — POOL 101-M-420-000 $45,11)0
PIAWWNG PEE — R00L J01 -000-41P-000 312,1111,00
T'
AND PLAN CHI"C"K.
LESS PREP11tVJ.`EES
NI
'NOW
IfIOTAL PERMIT VVEN OVE
NOV 17 1997.
DATE BY
INSPECTOR
1.11111111"010
$318.75
4
INSPECTION RECORD
b 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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test .
p
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
Z
Gas Piping
Gas Test
Appliances
Final
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)
' :� � �i Imo, �� � - •
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/ �' 36
s
74 � f
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CITY 0 LA QUINTA
BUILDING & SAFETY DEPARTMENT �� {
CONDITIONALLY,
ACCEPTED FOIA CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
-BY -
AREA SCA
'LAN -NO -SCALE -'
IIZE X O DEPTH PER SO.Ff. ❑INCLUDED
NO. r FILTER NO. � ? � I Za= � NOTE: SHALLOW END ..... ❑. LADDER ...... ❑
DEEP END DIG ...... 11 SLIDE ....... ❑
RETURN LINES !0 21r 7` S A
� P -TRAP .......... ❑ LIGHT IN SPA .... ❑
S_FT. FENCE �2 �' /3 SA �Z_O� BACKWASH UNE .... ❑ SPA ..; ...... ❑
/YIA�Y FILL UNE ......... ❑ ^":LORINATOR
I FUivr c HP �� ry�/_ 3r�
GRADING ......... ❑ ROPE RINGS ... ❑
c. ANTISYPH NYES z� �• :'-'j 'TtA
HEATER ......... ❑ ' MAINT. KIT ..... ❑
RICgLS(- FT. BONDING YES P� GUNITE INSP ....... ❑ TREES ......: ❑
C (2 S BOARD ........:. ❑ • OTHER ...... 1321) FT. TILE COPING N0.
LOT OWNER
�
T
E PALM ENTERPRISES zz JOB ADDRESS
POOLJSPA CONSTRUCTION COMPANY TRACT � � � Cy CITY � GAAP NO.
619.325-2187 -i% .�e� JOB PHONE71- /yl`% BUS. PHONE