9812-247 (RPL).I—
.0
cf)
04 LLj
o5M
r� d U.)
P�. LL!
o Z
Z6 O o
�(0
LLI LU
a.
U)
Z
M
LO
N
ON
U °)
CL Q
Z
Lo aCr
0
LL
Xw —
mQU
0.
rn H
Z_
co
�O
a
J
LICENSED CONTRACTOR DECLARATION T T
I,hereby affirm under penalty of perjury that I am licensed under provisions of
kS!Nipter 9 (commencing with Section 7000) of Division 3 of the Business,and
Professionals Code, and my License is in full force and effect.
License_I • Lic. Class Exp„Date
39725/2 C.SS 12/31195
ate �2
� Signature of Con ctor
OWNER -BUILD DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Co2,ctor'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 Policy No.
STNM FUND 051'7316-93
(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' compensatio�n"provva,'sionstof Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
y,Date: - / % Af Applicant r
r L
Warning: Failure to secure/Workers' Compensatiopcovggwage is unlawful and
shall subject an employer to criminal penalties and civil fihes up to $100,000, in
addition to the cost of compensation, damages as proviUe 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 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 forinspecrti6n purpose"s.
Si ature (Owner/A e'nt � , 71 lmAeN Date/lam �r
r g 9, )i ' v
-BUILDING PERMIT PERMIT#
'.11'112.24 7
DATE 121/311.98 VALUATION LOT TRACT
JOB SITE
ADDRESS 78-750 `FIA CARMEL
APN .. -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LYNNW. 1,CKJ'_P,'1,
SI_IEll1t KX)LS
78750 VIA C A.WEL
P.O. 'BOX 833
LA OU1NI-A CA 922D
PALM 0L1Stil21' CA 92it61
(6191568-4014 0•.1119 529
USE OF PERMIT
�c�tal, At�U/t��4t SFA
POOL KND SPA. ONLY
POOL rlMt*0R PA K300.00I. i
I S'I.3il4X1''i D COST OF WNSTRUCTION,
131:3130.00
PERMIT VVIE, SUMNI ".Y
!'9,,llN C.HWK FHE 101-000-439.318 3128.70
r0wSTR t tr,Tlow FF3T, I f11 -000-4I R-000 f R.ttn
h1w.r1wIrICA1 ITIS -_ POCA, 101-000- 4:1-000 5 1.1Nf
611,Ef;'1'liIC".AL FFA?. -- Kx-)L 101-000-1920-000 S ,1i (KA
PLUMBING FHE -- POOL 1.01-000-419-M S27.00
1
a
�SCTH.Tt1, AI, C:�':)Wrrj_T1C"T10N AN0 P! -AN (;N iCK
$47') 7n
I.US i PRE -PAID f^I T;S
50.00
DEC 31 1998
TOTAL I'F4MI't FEIN S I1'tiln; NOW
$422.741
RECEIPT
DATE
BY Y+. —•, giX':''DATE
f...._
FINA:EEb
INSPECTOR
INSPECTION RECORD
C OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL • APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS.
BLOCKWALL APPROVALS
Steel
.Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg, Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test 7 -
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
'Sewer Connection
Encapsulation
Gas Piping
L,c� �,!.—
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
'Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
NATURAL EFFECTS
AN EXTERIOR DESIGN/BUILD FIRM• -
73-960 Hwy.111 Suite 5 —Pahn Desert, CA 92266
Phone 760-568-6726 — Fax 340-9426
C-27/C-53IC29/C8.
License # 690377
August, 23 rd,'' 19-SI9...
City of La Quinta
Building &'Safety. Departme".,.
P.O. Box 1504
78-495 CDe Tampico..,
La Quinta, CA. 92253-1504
Attn: Kirk IG'r'klmkd
Re: Eckert residence.
Dar-$ir:
This letter is to verify that a plumbing pressure test•was conducted- for the swimming pool at the project noted
above.
The piping held- pressure at - 35P:S.I.- for over a peried-of. five -days,
Thank you for your time.
Sincerely yQyrs,
John C. Krieg
t
110