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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 and effect.
LiNse # Lic. Class Exp. Date
�6ate Signature of Contractor—
OWNER-BUILDER
ontractorOWNER-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 riot intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, 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.
('Xf 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 tamer & policy no. are:
i;,arner Policy No.
STATF, F LI I) 1061,137-98
(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' compensation provisions of Section 3,700 of the Labor
9�6e, I a 1 forthwith comply with�liese provisions.
vDate: i`�!�':: Applicant
Warning: Failure to secure Workers' Compensation ove els unlawful and
shall subject an employer to criminal penalties.and�civil fi es 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 his City to enter upon
the/above- mentioned propgdy4or'inspection pur osesf
Signature
(Owner/Agent—5�/ -4-�Date
BUILDINGPERMIT PERMIT# CONTTROLL#
DATE r k VALUATION LOT 9803-048 TRACT 8 6 io IT
11 :. (r, $13.000.00V
JOB SITE
APN
ADDRESS
45-0241 IDC.alt3_ IE DRIP
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CENWRY i_'Cdl'JWELL CONOVIONIT1'ES
UA'i`E PALM F3NTEJU')R1S1 S
1513,141 "D" S'I'REVF, 51'E. #200
?4-818 VCHE WAY .46
SAN BERNARDINO CA (—)2,108
PAWNI DESERT CA 92:260
i "'Gtl� �d6-? Sp J t_'P,L.k 11�1s8
USE OF PERMIT
POOUSPA 0N1Y_ M AkMS'/EIARRiJRS ARE TO Elis Oipi RAT[ONAL F%RI(-,R
TO EN-Cam'/PRF-PL ASTE7t INSPE+w' 101 1
I?CiOL ANI)„OR SPA 13,Oi'iO W LS
ESTIMATED COST OFCONSTRUCTION
13.111P1D.Glsl
PERMIT FEE SUNINUM
PLAN CHECK. FF,E 101.000-439-318 $93:60,
C=ONSTR IX7110N FEE 101-000.1-118-000 $144.00
,WFCHA1JICA,L Ff•3 — Pl-NA. 101-OW421-000 524.0+)
ELECTRILAL, FEE -- POOL 101404204” S45 00
PLUNIBINO FEE -- POOL. 101-000-419-000
CIO
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SLIB-TOrl'AL CO'NST'RU(,*TION AND 1'LAN f •HECK
LL SS PRS-PA11)1?IiES
TOTAL PERrUIT FEES DUE NOW
$333.60
RECEIPT
'7,=JAL
DATE8Y
DATE FINALED
INSPECTOR
�' i
,n
NSPECTM RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
1 UILD�HG APPROVALS
MECH Nw CAL 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 Firewali
Exterior Lath
Drywall - Int. Lath.
Final
Final
BLOCKWALL APPROVALS
POOLS , SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLLURfdBU6lG APPROVAL
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
Final
Final
Utility Notice (Gas)
ELECT=AL 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:
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POOLIEASC'ALIE 1w l..=
PLOT PLAN -NO -SCALE
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BUILDING & SAQTY DEP ARTMEt-J]""T"
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ACCEPTED.FoR CON""r-
717-4,uc-1 ION,
SUBJECT TO INSTAL LAT10"fJ AS P811
AND ALL APPLICABLE
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.NO. Lo FILTERNO. IJ -5 NOTE:
NO. RETURN UNES
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CHPAI1;n c7f BONDING YES 14'C f
3AS 1415'FT. TILE jLo COPING NO.
AID—,- ion -5 Q &da L! F -t 9-
DATE PALM ENTERPRISES
POOL/SPA CONSTRUCTION/LANDSCAPING
(760) 346-2504
CONTRACTOR NO. B -1;"3;C,27-490 775
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OINCWDED
SHALLOW END
DEEP END DO
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GRADING ...........
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May 19,1999
4
78-495 CALLS TAMPICO — LA QU1NTA, CALIFORNIA 92253 – (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1.227
Date Palm Enterprises
74-818 Velie Way #6
Palm Desert, CA., 92260
RE: Pool & Spa Permit 9803-048
Dear Date Palm Enterprises, '
The purpose of this letter is to nform:,you that your Pool & Spa Permit 9803-048,, for the
project at 45-020 Debbie Drive,;has expired. In -accordance with 1994 UBC section 106.4.4, no
further°work may be performed until a new permit has. been, issued.
Please contact Daniel P. Crawford Jr., Building Inspector I, at (760) 777-7012 to obtain any '
information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1). Abatement of the project through the City Attorney's Office and Code Compliance Division.
2) Notice of non -conforming structure placed. upon property profile.
3) Action filed with Contractor State License Board. Optional if Owner/Builder.
Please contact us at your earliest convenience prior to 10 working days to resolve this issue, and
for any questions you may have.
Sincerely,
Mark Harold
Build' g & Safety Manager
aniel P. rawf rd
Building Inspector I
cc: file
dpc
MAILING ADDRESS P.O. BOX 1504 LA QUINTA, CALIFORNIA .92253