9512-020 (RPL)(n LICENSED CONTRACTOR DECLARATION
F- I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
C,JW Section 7000) of Division 3 of the Business and Professionals Code, and my
Z) M License is in full force and effect.
v � 6 f 7S C63 16/3'1196
n W ^ License # J. Class Exp. Date
Date , Signature of Contractor 1, L �0 f l
Z�
F OWNER -BUILDER DECLARATION
LL
I W 1 hereby affirm that I am exempt from the Contractor's License Law for the
CL following reason:
F- (n ( ) I, as owner of the property, or my employees with wages as their sole
Z 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).
( ) I am exempt under Section B&P.C. for this reason
�
Date Signature of Owner
N
rn WORKER'S COMPENSATION DECLARATION
dQ I hereby affirm under penalty of perjury one of the following declarations:
C) 2 Z () I have and will maintain a certificate of consent to self -insure for workers'
LO r H MO compensation, as provided for by Section 3700 of the Labor Code, for the
X W W performance of the work for which this permit is issued.
O J J ( ) I have and will maintain workers' compensation insurance, as required by
m Q U Section 3700 of the Labor Code, for the performance of the work for which this
O U permit is issued. My workers' compensation insurance carrier & policy no. are:
CL LO
Z Carrier ��c'Zc�1.i� Policy No .,
_ (This section need not be completed if the permit', aluation Is for $) Ob.00 or less).
n =)() I certify that in the performance of the work for which this permit is issued,
C3 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_,3700 of the Labor
®A Code, I shall forthwith comply with those provisions
Date: i <�Applicant 4,4
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 3708
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 application agrees to, & shall, indemnify.q /
& hold harmless the City of Indian Wells, its officers, agents and employees. ,
2. Any permit issued as a result of this application becomes null and void if J
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. (J
I certify that I have read this application and state that the above information -s/.
correct. I agree to comply with all City, and State laws relating to the building -
construction, and hereby authorise representativ�esof this City to enter upon the
• above-mentioned property for inspection, purposes.
/Signature (Owner/Agent):� /i % t+"�1✓ Data -L, - -114
N
A"'
BUILDING PERMIT
PERMIT9i '020
DATE 121 &95
VALUATION . $I0.0(Hl.Ot
LOT
TRACT
JOB SITE ADDRESS
78-585 DESCANSO
APN
"6-340-002
OWNER
CONTRACTOR
CA1.1Y'O NIA POOLS & SPAS
MFLEAN
41910 BOARDWALK. #A2
785.85 D.ESCANSO LN
PALM DESERT CA 92260
LAQUINITACA 92243
(6519)340-9000 CBL# 355
DESIGNERIENGINEER
USE OF PERM FOOL ANDIOR SPA
FEE DESCRIPTION
FEES_
1'C? L ANIDJ412 SI'A 10,ii(M .00 LS
ESTIMATED COST OltCONS9RUCTION
10,000.161
TY3IQF.�,�84
. 7VYKY
;PLAN CHT --*CK FEE 101-000-439-318 $76.05
CONS'TRUC i'f.ON FFE 101-000-4.18-000 $117.00
&IECHANICAL F1W, -- POOL 101-000-421-000 $24.00
ELF, -i`t2Ir...AL FEE — POOL 101-000-420-000 $45.00
PLTJr4fB1NG PIES -- POOL 101.-000.419-000 $27.00
SUB -TOTAL CONSTRUC"110N AND PLAN CJiECk
W0,05 ..
qLESS PRE -PAID FEES
' S0.00
0
19ec TOTAL PERMIT FC&S DUE NOW
1,9,1995
y
5259,05
RECEIPT
DATE '
BY
DATE R14ALED
INSPECTOR
tr-
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
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment- Location
Underground Electric
Underground Pibg. 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
Final
COMMENTS:
/GLS le Z
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)