9512-053 (RPL)•,, LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 690794 � 53 11130j45
L.ick�nse # Lic. Class ( Expj Date
Date %2/' s� -SignatureofContractork;;k .I`-A{r4;,.
OWNER -BUILDER DECLARATION
I hereby affirm 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 STA'1 E PU.ND Policy No. 10830321%
(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 hall forthwith comply with those provisions. {
'Date: % s 1116— ADDlicant 1114,'/ l7 art p •�
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 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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/�}.,-e t •_ � ,!"f�'`'' '
A"'
BUILDING PERMIT'
PERMIT�S,��
DATE 1ZII119
VALUATION N.10,.Xf##AJ11
LOT
TRACT
JOB SITE ADDRESS 49-2-35 VIA ROLE110
APN 646.291-035
OWNER
CONTRACTOR
UNIQIJF :FOOLS BY CARMINE
RENADO Ct]ULDLOCK
74818 VEL1.E WAY #1
49235 VIA BOLERO
PALM DESERT CA. 92260
.LA QLTIN 1'A. CA 9.2253
(619)34&6335 CCL# � ")
(
DESIGNER/ENGINEER
USE OF PERMIT OOL AND/OR SPA
POOL AND SPA
FEE DESCRIPTION .
FEES
COW RACP AMOUNT 10,500.00 LS
A
Y,
�a
EST MV TED COST OF CONSTRUCTION �
10.500.00
PERM IT FEE SUMMARY
PLAN CHECK FEE 101-000-439318 $81,90
CONSTRUCTION FEE 101-000-418-000 $126.00
MECHANICAL FIX — POOL 101-000-421-000 $24.00
ELECTRICAL FEE -- POOL 101-000-420-000 $45.00
PLUMBING FEE — POOL 1.01-000-49.O00 $27.00
Q o
1
J
DEC 11 1995
Rv
_
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
^ $303.90
LESS P.Rf -1?A1D 8ES
$0.00
TOTAL VERMIT :FEES DUB; NOAH'
5303.90
• •T
e
RECEIPT
DATE
By
DATE FINALED .
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
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 /3
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test / qs
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
/3
Gas Test
Appliances
Final
COMMENTS:
*,/04G
/�y—//L��T
f� / //
1101Ar 17Z 114W AIW /or Vg/F�
/ //
`j0�.jOf(%!1 D� l/li%� op'l
J
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619)" 777-7000
FAX (619) 777-7101
December 24, 1997
Renado Gouldlock
49-235 Via Bolero
La Quinta, CA., 92253
RE: Pool & Spa Permit #9512-053
Dear Mr. Go.uldlock
The purpose of this letter is to inform you that your Pool & Spa Permit #9612-053; for the
project at 49-235 Via Bolero, has expired. In accordance with 1994 UBC section 106.4.4, no
further work may be performed until a new permit has been issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete.the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
3) Action -filed with Contractor State License.Board. Optional if Owner/Builder;
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,.
Mark Harold
Building & Safety Manager
Daniel P. Crawford r. `
Building Inspector I -
cc: file
dpc
MAILING ADDRESS - P.O..- BOX .1504 - LA OUINTA, CALIFORNIA 92253 ��