9711-059 (RPL)'f LICENSED CONTRACTOR DECLARATION
N I hereby affirm under penalty of perjury that I am licensed under provisions of
F— -I Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE
`C w ee I Professionals Code, and my License is in full force and effect.
License # I Lic. Class Exp. Date
Ci
LLI
397252) C53 1 V31/98 ADDR S
oZ � Date Signature of Contractor _ owNER
O O
BUILDING PERMIT
VALUATION LOT
79-? 1,AURIE COURT
J V ca OWNER -BUILDER DECLARATION SCOTMAM- SON.
IIJ W ~ I hereby affirm and r penalty 6(perjury that I am exempt from the Contractor's
Compensation, will do the work.' and the structure is not intended or offered for .
sale (Sec. 7044, Business & Professionals Code). USE of PERMIT
( ),. 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 POOL Alm sPAONLY
N Date'! ' Signature' of Owner.
fl
Q �Q WOR(ER'S'COMPENSATION DECLARATION
Z I hereby.affirm under n
pe alty of perjurer one of the following .declarations:
p (.) 1 a Certificate of consent to, sell -insure for workers'
Ji u- ootpon Atl provided for by Section 3700 of the Labor Code, for the POOL ANDM SPA
�}` J 4he wa*k for wtnct3 th
. ., perrnrt85•+ssugd. .
(. )': t it�vieidN 'rr►airNalrr wOiiEerS'' oompett8atron irrstoe as required by
37fJO of Ifie Labor Cdde, for the polbrmaince to the work for which this
pettttit is issued. tvIy workers' compensation insurance carrier & policy no. are:
:.. Collier Polley No.
PERMIT & CONTROL M
"11-09 TRACT 6-267
APN
JTRACTOR ! DESIGNER / ENG NEEM
,,�SUNAIR.POOLS
' I-P.O.-bOX 835
PALM DESERT
{619)5%&4014
13,9
)� STATE FUND 0517316-97
ESTIMATED COST OF CONSTRUCTiDNt
(TTflk-section need not be completed if the permit valuation is for $100.00 or less).
PERMU FE1E SUMMARY
( ) .I certify that In the performance of the work for which this permit is issued,
PLAN CHEM FESS 161-000439-118 599:45
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
CONS7RUCTTON FW 101-000-418-M 5133.60
se ject to tlje.workers corttpiertsation provisions of'Section.3100 of the labor
h6i.0 iATIICALM—POOL 101_000-41�000 324.00
Code t shatFtalftwith comet Qth tttose:prbvisioris:
ffi,19C7RICAt F'fE -- IPOt'A. 101 Ott -42a-000 S4 5:00
A licant .
- �
P[.Uli�+iCf F�—.POOi.• 1Dl=0Dtf-419-4i)D Sti7:ao ' .
Pattaue3o secure Wiirlca5r>;,tdtf�pr�tltAn i:6iialag@ is uhlaWftll and
't�i an �empl¢y�er to,�Grtmlt'tal � arSd dtAfiln� •up tb $i�.b00, Ih ..:;
.. . '
atil9tt)tin tb:fte 6l CotrtEfAiisatton; gatite0es eta j>rovtded`for in Sdtfijfi 3706
of !fie,Li*i r Cotle lntei�sf ai d attorney's flees.
IMP64TANT Applkation is hereby, made tothe Director -of Building end Safety
for -a • porMit subject to the conditions . and restrictions 'set forth on his
application'..
1. Each persoh upon whose Behalf- thfs'application is made &' each person at p'
'
Ohm -0 --'request and for whose bene`fltwos9t is.peribfttVd under.or pursuant to .:
a* iy.Omnit issued as a resulf of this:app. paton agra$s: to A=sha)1, OIL —n -'
SC1H-YCiTAL •CHECK
(�ONSIRUC7ION AND PLaN
&'hditt harrWess the City: of :La t'�titrft:-its officera, age ts:�and m3ntptoyees:. -.,
Y
"AM—FEES
Z: Any permit issued as a-re$ult df Ais�pfidation'V60omes. null anti-'void.rf
work,4s'not commenced within .1190 •daya from date :of: issttanod sof such'.
'perrrnT, or cessation of work'%r.100 dayf; tviit `subteet pemttt to caneeliation
TOTAL #'ERMIT.-REES`Dur NoVV
I certity that I flava read this'Bppllcetipn anti state that the above:inforrnatl6h,Is
.
correct. I agree, 1o, comply with. all Cjty,'and ;iQie laws relating to the building .
constiuction,.and'hereby authorize represt3ntatives of this Cityto-enter tiidn
the above-mehNoned property for Inspection pifiposes.
RECEIPTBY
I� !
j
DATE FlNALED-
YNSPEf
Signature (Owner/Agent) -._ Date
�
CA 92261
CBL# 529
13,!50.00
5348.45
$0.00
5348.45
SUNAIR
POOLS
�Y»,W 1974.
SUNAIR POOLS.
c9wimmin9 Ad
Designers & &dders
between Sunair Pools, and:
Customer's Name
Date
PA.BOX 835
PALM DESERT, CA 92261
Phone (619). 568.4014
STATE LICENSE C•53.397252
for work being constructed at:
Job Sit dre s
CONTRACT DATED: to be adjusted as follows:
AT AN ADDITIONAL PRICE OF _ ACCEPTED this day of
AT A CREDIT ADJUSTMENT OF (_ ) SUNAIR POOLS:
PAYMENT DUE AT
OWNER:
Ld NOTE: PLEASE SIGN WHITE COPY AND RETURN TO THIS OFFICE.
19
10 SUNAIR
POOLS
y"'er 1974
SUNAIR POOLS
Swimming 95001 .
Designers & Builders
ADDENDUM. CONTRACT
The contract between Sunair Pools, and:
Customer' Name `
vl - 2 --VQ 04Va
-1 -e
Customer's Mailing Address
11
for work being constructed at:
CONTRACT 'DATED:
P.O.BOX 835
PALM DESERT, CA 92261
Phone (619) 568.4014
STATE LICENSE C-53-397252
Date �Z_ �7
Jr--% Salesman
-C— Job # Z07
Job Site Address
to be adjusted as follows:
AT AN ADDITIONAL PRICE OF $ ACCEPTED this day of 19
AT A CREDIT ADJUSTMENT OF ($ ) SUNAIR POOLS: By
(Title)
PAYMENT DUE AT '
OWNER: '
1 NOTE: PLEASE SIGN WHITE COPY AND RETURN TO THIS OFFICE.
i
j