0212-149 (RPL)It=w
LICENSED CONTRACTOR�DECLAR'ATION t'
I hereby affirm underrpenalty of perjury thaY;I Um 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,, td!`
616+11
..
Date ° d~ ' 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).
( • ) 1, 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 POND Policy No. 04 6 1 0 119 70,
(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' compelsat`on provisions of Section 3700 of the Labor
Code'' s all f rthwith comply with tho�se'�gp vision&..
,°aDate:"� Applicant
Warning: Failure to secure Workers' Compensation coverage is -unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
.,of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on hi's
application. '
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to'
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
,2. Any permit issued as a result of this application becomes null and. void if
work is not. commenced within 180 days from date of issuance of such,
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify. that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby „authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)� Dates
f :BUILDING PERMIT PERMT99"R�99jjIy�
p ��}}(�
W1212- 49
DATE VALUATION LOT TRACT t,
MAU= a$f1S OWAV d
JOB SITE
ADDRESS rS{D,�bC� �rd�IQII!
APN
OWNER
CONTRACTOR / DESIIG+NER / EN 1NEERSLP
POGLa AS
77-W M 7LN'.1M'Y M" T;RTVL O' Jf),7,137
P.0o. B(YX
3?AU4 IN.M.NT CA, 92211
LA QW -WA 'CA '92233
pm)360-35th LS1al, 19445
USE OF PERMIT
POOUSPJ9�.A.i.,Aa2.Ma1B.4t:tt.R'iM SHALL BE IN PLACF.&T PM -P AsTER
INOW1101T, 1&.QUfP%U1i? TENCLOISUP9140t INCLUMM
PfiOt. VIVIOR HPC. L -S
MI w,x 13w, Sul RY .
PLAN 014ECK YRE 101-000-4394518' $10339
CONSTRUCTION PU 1.01.0004.18-W0 $16100
ME, MiAMM FEE,- POOL,' 101,-0004XI�000 S24100
EL 7`kttCAi FZF. as A010L . :''.1.01'_000-420-000 a;5.nf1
PLUMB.tA1G FEF POOL 101 -000-4 19m000 $27.00
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JA 02 2003 1�
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STJB-Taf K, cV09W'RTYC,1110V AND MAN CMUX
$3613.30
JX.93 Mg -PAW FEM
$0.00
-TOTAL YXIMUFFES M, NOW'
RECEIPT
DATE / /
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I 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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
'Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location 14,
"
Underground Electric i
Underground Plbg. Test A!J—
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 3-12– '03
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exte " r Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
L. 29'-0"
1 51
{ r . INFINITY EDGE k
' L , Via., •. - - ` -
- a . %j fie a ••'+':_ i Nl. , � _ .
TILED SPILLWAY 8,,0
` y= SPA +18".'
-CITYOF ,LAQUIDTA;.•a
wav
BUILDING & SAFETY DEPT.
-
a 4k,
f
APPROVED-.
FOR C NSTRUCTION'.
`•L f - l a j- � S YN _
` NOTE: LANDSCAPE NOT INCLUDED
Pn:SVECS
5 -a.
REVISIONS: BY:
.POOL &-.SPECS - ` •
POOL SIZE: 17:6" X29'
POOL AREA: 388 SF •
POOL PER: 8 •
POOL DEPTH:
PA SIZE. ' DIAMETER
PA AREA:. 8 SF, -
SPA PER: 22' •
DECK AREAS 794-
PATIO
AREAw 'w
MISC: =` =
C� r
So - � v
CITY:.
LOT # : � A t;.Se
DATE: -
SCALE: 1 "=81•
DRAWN B
JOB:
r
Pn:SVECS
5 -a.
REVISIONS: BY:
.POOL &-.SPECS - ` •
POOL SIZE: 17:6" X29'
POOL AREA: 388 SF •
POOL PER: 8 •
POOL DEPTH:
PA SIZE. ' DIAMETER
PA AREA:. 8 SF, -
SPA PER: 22' •
DECK AREAS 794-
PATIO
AREAw 'w
MISC: =` =
C� r
So - � v
CITY:.
LOT # : � A t;.Se
DATE: -
SCALE: 1 "=81•
DRAWN B
JOB:
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