0007-158 (RPL)LICE ED. CONTRACTOR DECLARATION
I hereby affirm under'' Ity of perjury that I am licensed under provisions of
Chapter 9�(commen` th Section 7000) of Division 3 of the Business and
Professionals Code,' License is in full force and effect.
License # Lic. Class Exp. Date
b5G12S C53
IDate Signature of Contractorr-
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 carrier & policy no. are:
Carrier STATE FUNI . Policy No. 046-0040006169.00
(This section need not be completed if the permit valuation is for $100.00 or less).
certify that -in the -performance of the work -for which -this permit'is issued,---
I
ssued,--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
(Rode, I shall forthwith comply with those provisions.
Date: s Applicant `J -
.,
Warning: Failure tozsecure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up t6•$1.00,000, in
addition to the cost of compensation, damages as provided for in Section 3.706
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.
Icertify 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)" �-��' `�---� °` Date
_4.
�f BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS .,5-746 SOT)r I~=T n3
-
OWNER =
CONTRACTOR/ DESIGNER/ EN INEER
1i. C. HOBBS C'01t4PAMY' R C
CAKMORNIA POOLS & SPAS
14301, CHAPMA14AVE
74-725 JOAII DRIVE, #A
ORANGE CA 92866
PALM D& kof CA 92260
(760)340-9000 Mo 355
'
USE OF PERMIT
POOL. MD101t 8 PA
POOL &SPA ONLY-E9,1..ARMSXRARR11sRS SHALL BE rN PLACE AT
PI.&PLQAZ ER INSKt✓1' ON. �
VALUATION I.,S
c
XS1'Z0TAT= COSH OF COMMUG°i1ON
�S,Q5i10.t3i1 ",
PrR11/li r rEiR summARY
PLA14 CHECK FEM _ _. _101.000-439-316
—
COINSTRUCT1ON FEE $171.00
—
MECHANICAL Te E "- POOL 101-£ WA0 1.000 $24,00
aJ•1,:ACTPICA.L LVEF, -- POOL 101-040-420-000 $45.00
PWM01Wd Fen poli, 1.01.000.419«0011 127.00
SUBTOTAL d -ON. MUt �' 09 AWD PLAN CITECiC
$378.15
7 M33 PRE -PAID FM
4;0.190
TOTAL PII IMI DUB. IS OW
RECEIPT
DATE
BB/Y.t }y
DATE FINALED
INSPECTOR
4
W
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Combustion Air
Exhaust Fans
_
F.A.U.
r
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
a6o 4-A
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
S b�
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fndures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: