0005-283 (RPL)C'4
Od `M
' W
oZr�
CZOOO
~
�(0V�
LLl Uja
In
Z
. LICEN6ED TRACTOR DECLARATION
'herebv,;.fiQm under l5enalfy of perjury'that I am licensed under provisions of
CICf r 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. ate
' 351673 CS3' A1i31l2t
Date — r 00ignature 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).
O 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
perfor ance of the work for which this permit is issued.
I; 11 have and will maintain workers' compensation insurance, as. required by
Sbeftn 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. ;
STXfLe FUND: A, 2%4-fl0-0Dt9334
(This section need not be completed if the permit valuation is for $100.00 or fess).
O I certify that in the performance of the work_fo`r'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 i L should become
subject to the workers' compensation provisions o `S .ti 700 of the Labor
Code, I shall orthwith comply with those ovlsio
Date: Le hnApolicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1 00OOO;;.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
fora permit subject to the conditions and restrictions set forth on his
application,-
1.
pplication,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 representati a of this City to enter upon
the above-mentioned property for inspe do u ses.
Signature (Owner/Agent) • Date
BUILDING PERMIT PERMIT# • . ' ':
- 0•,283
DATE fVALUATION LOT,. TRACT• $14,44APP
JOB SITE
APN
_ _
ADDRESS 47--70.51 VIA 1L16.i` IANA
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CANl4DA Y A COWANY
MAL HAMYrON dba VACAnON POOLS
17480 Z I I'M ST. 4106
9522,, DONALDSON RD.
.l"C YWR CA 92780
1, CVhM VAL'_ EY . " CA 92356-
(909)248.6045 CBLA 4335 '
USE OF PERMIT
POOL ANDIOR SPA
POO4 & SPJL 011 -AL.A` RMSffiA .1 IP= 5114I;L BE IN PLAC AT '
PERE-PWTZR D4SPBdT1O1K POOH. RQUII'M`t t�lT ENG 4SUR)l NOT
.114C1LUDED IN THIS PERMIT. ,
A
IVALUATIOAI i4,40{1,4SI L9
�•
.
s
1~°ROA91 71 Kb' KWSARZ'
PL" CHEC-9 FEE 101-000.439-318 $104.30
#- .
COWNTRUCTIOW FEE 1011-000-418-000 $167.00
1'd£WHA141CAL FEE -- POOL 101.000-421.000. $24.06
ELECTRICAL; TRIC;AL; PEE — POC IL. - 101.000-420-000 $45.00
f "• ' • -"'-
PLUMBING FEE •- POOL 10'14000.419-000. $27;04
a
..r..;• � iw r
I
r r
F• . .
SUB-TO"�A CONSTRUCT A�11� PLAN C:l t:'1e
$383:30 • ,
1 Fzs PREPAID TLY.a
TOTAL PKIMT DUEENOS
s �.�ttD,
RECEIPT
DATE
BY
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
OX 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
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
Finales
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)