0009-218 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HCha -ter 9 (commencing with Section 7000) of Division 3 of the Business and
CV w Profe'kSionals Oode, and my License is in full force and effect.
0 :5 ch License # Lic. Class Exp. Date
I,- W 672850 l-Im y W3012C
Z Date- �- Signature of'Contrcigr y%� �---•- -•
�Or` c
J F- C) OWNER -BUILDER DECLARATION
W UJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
rn
Q WORKER'S COMPENSATION DECLARATION
? p IM I hereby affirm under penalty of perjury one of the following declarations:
Lo � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w 4-- compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
CD Q CJ ( 1,1„havd nd will maintain workers' compensation insurance, as required by
p 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
li H permit is issued. My workers' compensation insurance carrier & policy no. are:
co 5 Carrier IFIZEMI 14T 8t�1P1.4T'1+ Policy No. iWC:'N3056022
. C3
J (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' compensaflon;provisions of Section 3700 of the Labor
Code, I shall, orthwith comply with those provisions.
Date f) Applicant
1 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 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_for/,inspection purposes,.
Signature ' Owner/Agent) /! : i'.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
$11,f10tD.41Cf
JOB SITE
ADDRESS 79-6731'umDPum mm
APN
- -
OWNER
CONTRACTOR / DESrGNER / EN INFER
WORM IYEW.1,.G3PRdENT,140.
GA1'IUS0 POOL.P.LUJvIENG,113C
74-333 HWY 111 SM 103
667QyM4B RD,
P,AUVI IYFZWf CA 92260
PALM SPRINGS GA 92261
(760)327.1592 Miff, 816
USE OF PERMIT
P001, ANL/OR SPA
POOL &SPA ONLY, ALLARMSISARRIERS SfIALL. BE IN PLACE AT PRE
PLASTER INSPECTION POOL P-QUII'Pd RT MCLChSURE IS 140T INCLUDED
IN THIS PERMIT
POOL AND/OR SPA 11,000.00 L8
NSTI i/rATED COST OF, C'ONVI RUC:710N
11100010D
!YE?rY1d (f 1f'kT HMMARY
PIAN CHECK IEE 101-000-439.318 $81.90
CONSTRUCTION F&L: 101-000418-000 $176.60
WC HANICAL FRE -= POOL 101-000-M-00% $24.00
f l,Ec,rRIrAL FEE — POOL 1'01-000-42+0-04 $45.00
PLUWINU �'.I?
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
Is 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
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test5��
Gas Piping
lC`
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
�3
f (l:
Gas Test
Appliances
Final
�q(p
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:
09/28/2000 08:21 7607784920 GATTUSO POOL CORP
a
iI
PAGE 02
,4m o" w.?5592 irsel i1 S1D
LW4E * 6125,
{ A RE -INSPECTION fE ✓Of
Will BE CNARAM If IN APPRONEt!
PIANS AND !OB CARS ARE NOT 01
THE SITE FAR A SCMEDUM
INSPECTION,
RO sclp 1 l
• CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCT
DATE
l/�