9603-035 (RPL)v7
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LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and,Professionals Code, and my
Liconse is in full force and effect. 6561.78 rF C53 10i31196
;License # Lic. Class Af " Exp. Date
Date 7•. r Signature of Contractor,/:.-
.
OWNER -BUILDER DECLARATION
I hereby affirm 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 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
WORKER'S COMPENSATION DECLARATION
!,,her be y 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 371 of,tiJen or Code, for the performance of }ham work4 .which this
�. ir'{ �v� S�:�J A y U.: J
permit is Issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(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 3700 of the Labor
Code, I shall forthwith comply with thoe provisions.,--,
Date: : A f Applicant1r'
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 application agrees to, & shall, indemnify
& 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
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,l have read this application and state that the above information is
correc!/.l agree to comply with all; City, and State laws relating to the building
construction, and hereby authorise representatives of this City to enter upon the
aab6ve-mentioned property for iinspectio/mpurpjoses..
Signature (Owner/Ager �'' y` ` 1' . i. ��7 Date
ALC '
BUILDING PERMIT
PERMIT.,Ip
DATE / 01YO
.flit LOT
VALUATION 577
TRACT
JOB SITE ADDRESS 73-6555 i ESSCANSO LANE
APN ir4"0_006
OWNER
CONTRACTOR
CA.IJFORNIA POOLS & SPAS
DANIELS
41910 BOAi'MIVAILK rr'.F',.?
75665 OCI:Si ANSO LN
PALM DESERT CA 92260
LA QUIMNX. CA, 92253
(619)344-9QQ() CBf,#F 355
DESIGNERIENGINEER
USE OF PERWTJW. L ANUIOR SPA
.P00J, ANI) SNA.
Y R.FAR "Y. A.RI3 SM RACK RIM(YCTION APPROVED PE,'t'tz Si3A fob -397
FEE DESCRIPTION
FEES
P001, ANUIOR :IPA. 11,0190.00 LS
.ii.�`.B3�tR'isA'R'£l:li (��'!�:!' �tP aC�i�t:�7t•ff.tliv S'!?�!�
11I.,f9titl.lii!
PERMIT FEE, SUMMARY
PIAN C14RCK VhX14)-)00-43�-I-A1 R $91.90
CC1.NSTRUC 110N 1-C 101 -000 -118• -SQ $126.00
1V[6a,1(.Nil'AL VIE. -R. -- PiDO. 101-000-421.-000 $24.00
RLECTRY'A1,.FEF -- .P(XL 1.01- loo-d2Q=444 $45.00
1'1;11M14_i,N(1 FF,,'F -• PCIQL 101-000-419.004 $27.00
B-,'FM'AT,. CONS RUG1110N� ND 1?:im,/QN (:1�);l C-IX'�-=�L�:SS
/��SI.
.�"32.�-Pf17L1 S
}�Fs
F?nz
'TOTAL PERMIT FEES DU NONY
$31f3.'i0
MAR 08 1996
8y
`
RECEIPT
DATE
BY
DATE RNALED
INSPECTOR
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 a SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
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
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final.
COMMENTS:
i
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)