9805-014 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under 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 an effect.
License # Lic. Class Exp. Date
C53 10/31/98
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).
( ) 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.
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.
STXf6 Fbr.ND 046-98-0006168
(This section need not be completed if the permit valuat on 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 soas to become subject to the
workers' compensation laws of California, anglagree that if I should become
subject to the workers' compensation provisi?'S ofld cti 3700 of the Labor
Code, I shall forthwith` comply with those prpvDions.
Date: Sr; -7 r Applicant—
Warning:
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 pro hided 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 nd state that the above information is
correct. I agree to comply with all Citylnd State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the a ove-mentioned property for i spection purposes.
ignature (Owner/Agent) r Date
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT 9805-014 TRACT 7622 6 I� �.
.k . $13,5(10.00 G
JOB SITE
APN
ADDRESS
78-758 V.IA CARAMEL
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TD DESERT DEVELOPMENT
CALIFORNIA POOLS 6; SPAS
79-295 RANCHO LA QLflNTA DR
N-725 JONI DRIVE; #A.
LA QUINTA CA 92253
PALMI DESERT Ctrl 92260
(760)340-9000 CBLi# -355
USE OF PERMIT .
POOL AND SPA. ONLY LAI t 1 �N %66
fi
:POOL AND/OR SPP. 13,500.00 LS
�gg8
nfl
0 5
ir 0 4i+
i
ES'.rll I ATED COST OF CONSTRUC't1ON
t.l,�llil.stpf
PERMIT FETE SUMMARY
01
PLAN CHECK. FEE 101-000-439-318 $99.15
CONSTRUCTION FEE 101-000-418.000 $153.00
MECHANICAL FEE -- POOL 101-000-421-000 $24.00
BLEL-MCAL :F.HE — POOL ' 101-000-420-000 $45.00
PLIUR413IN0 FEE — POOL 101.000419-000 527.00
SUB -TOTAL CONS'fRUCI`lON AND PLAN CHECK
$348.45
LESS ,PRE -.PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
5348.45
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
BLOCKWALL APPROVALS
steel
POOLS - SPAS
5 — 2
Set Backs
Electric Bond
— 2 -
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
S - -
Underground Plbg. Test
-
Final
Gas Piping
-
PLUMBING APPROVALS
Gas Test
Electric Final
y
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
— p -
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
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
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: