0006-378 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code,.and my License is in full force,and effect.
O M License # Lic. Classti Exp. Date
p LLI`n .536236 C53 `, it
CZO /Date Signature of Contractof--��
0 OWNER-BUILDER.DECLARA ION
FW- Wtl I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for'the following reason:
Co.,
'; ( ) 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).
ce) () I am exempt under Section , B&P.C. for this reason
LID
�1! 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.
.) 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 carrier & policy no. are:
Carrier STATE FUND Policy No. 1576269
(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 ofr'California, and agree that if I sho(t��Fb
e
Subject to the workers' compen' anon provisions of Section 3700r
Code, Ishall forthwith comply wit hose,provi ons:. r.1; r^
:JDate:, Applicant ^ _
Warning Fai re to secure Workers' C nsation coverage is unlawful and
shall subject an employer to crimin�al peh altie's and civil fines up to $100,000, in
addition to the cost of compensatidn;�9amages 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 propefty for inspection p rpose
ignature (Owner/Agent) r ate f
:' ��.
BUILDING PERMIT PERMIT#
Q00Eiw3'f41
DATE `" VALUATION �n� �k LOT TRACT
JOB SITE
ADDRESS ]�l]�Rt3R.00. Ya1�I�i
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
JOrt CAPK A
£SUN. LO -Z POOLS
45.565 UT;R1,1 ROOK
4*10213 MK1:101W TR,
LA.QUINTA CA 92253
PALM i DF -SM CA 922.51
(760)340-5521 CRT.# 16M
USE OF PERMIT
PWI AMINOR SPA
N
POOL. & SPA ONLY4.L.ARMSIBARRILYRS SHALL 119 IN PLACY•P PRK
PLASTER INSPECTION.!'001, (-.QUIP ENOLOCURK I;3 N(YF 1NCLDUI?.I7 IN
THIS PERMIT
POOL. AN MR. SPA 00,00 13
t
f3
ES17.1!'i N17W COST or CONSI'itUC%ON
14b5W,W
PJa:1d1IrITi'FkT SUARiw"Y
�N CIIECK FRE 101-000.439-:31 S $105.30
.}14lSTRUCTION I?KZ 101-0004'I5-000 `1162.00
MECHANWAL. FEE -- POOL 101.000-421-000 S200
ELECTRICAL. FEE — POOL 101-000-420-000 16o.i7Ul
PLUWIDINO FER -- POOL 101.000.419.000 $21.00
MTf-1,-T0TAL CONSTRUC 710N AND PL Akf Ci;1RM
$363.30
1XS3 PRP: -PAID TrE:F19
$0.00
*.CO AJ, »+M•: MS DUE NOW
i
RECEIPT
DATE
BY! "...
DATE FINALED
INSPECTOR
OPERATION l DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
OX to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wali Firewall
Exterior Lath
Drvwail - Int. Lath
OPERATION I DATE I INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F,A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
2�a
Set Backs
Electric Bond
!j
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
Test
•rr••
Final
C�QI�L�I� 'P- \-2--T)
��
Final pp roS FS -a '-4 r `GZ t Cs
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.L.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
(760) 840.5521
PALM DESERT, CA
GENERAL SPECIFICATIONS
REIURW l IYKS i i i
SPA SPECIFICATIONS
SIS: 7 '
SHAPE c U s -r o M
JETS 4
RAISED 12 "
BENCHES
TNS CAhrLA FAMILY
455-5651 t9r-F-p[31?OC
LA QUIN-'A, CA
APPROVED BY.:
THIS DRAWING REMAINS THE PROPERTY OF SUNRISE
POOLS. REPRODUCTION: OR UNAUTHORIZED USE
WITHOUT PERMISSION IS PROHIBITED.
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