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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.
License # Lic. Class Exp. Date
777601 C53 HIC 413:9104
Dr C Signature of Contracior.!�-�.�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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
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 S'T.A EFUND 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 workerscompensation provisions of Section 3700 of=the_ Labo.r_.,....
ode,•l.shall forth_�wit com ply with those r_ovisions P .�.
Date:, >r e�� ` Applicant r,,.- � � ''�;":'� Y --?-•
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 repres6tativeso,66 this City to enter upon
the above-mentioned property f r inspec`tio, .purposes:"
Signature (Owner/Agent)f%�` f �.- 'N- Date,��
BUILDING PERMIT PERM'Tw7
f
DATE / LOT TRACT
$
:_�VALUATION
,Woko
ADDRESS �'�•� 10iZl� A�
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PICUARD :E. MITUS MIT
CAUNEVADA POO..LS, 5TC,
S•4S03�L5 t'T r
70-180 11ILME R R.OAD10
Uk QUIN-TA CA 92253
RANCHO MRAGE CA 922 70
(760)831.08130 Mil 3;35
USE OF PERMIT
FOOL AND/OR 2 A
- - - ..__ ..- .._._
_f�i. [:.r` I.tV l'Ysf25..L• .E1 i ,1Y .!P.'1.f5.7 d 4.SG
!' 6J1✓Ji'.e3, �ii.li, YtbEik:.kLlCiS.5.7i ,,
TWSPECTION. EQUIPMENT VC60SURENOT INC -LUDED
POOL.ANDJOR'VA. 39,00 100 LJ
'ITS %m,. = cosr Oi` caNS:l."RIJMom
PFJ?Mrf IME SUMMARY .
PLAN CT I ECK ME 101-000-439-318 52221.95
CONSTC<dJC7iON FEE 109'000-418-000 $343.00
MC:M. 141CA1, ME •- POOL Y OI 8000-421.000 $24,00
]P..3:i+.CTRICAL t-13? . POOL 101-000-420-000 445-M
d'1,,UMSTIITO FEIN • PQL7I.. 'I 071.•,000-419-000 VIM
a '
0
pl
b9A+R 2 4 2003
CITY OF LA QUINTA
7R)ANCE DEPT
SUB. -TOTAL
5,669.93
�., . JM3 FRE-IIA133 kT,'W-
RECEIPTDATE
%r, /()/3
BYY
DAjE FI D
I SPECTO
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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
A
Set Backs
Electric Bond
0
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
11A I 1Z
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
WateCPiping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer•Lateral
Pool Cover
rA
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Apoliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit .
Rough Wiring
Low Voftage 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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POOLS
Mark V. Touw
70180 Thunder Rd.
Rancho Mirage, California 92270
Fax 760-770-7774
OWNER to fence.pool area and install s*ad cimwV and self gates per code.
NOTE: No dirt will be removed, rotumed or graded after day of v=vabm
N,:TM! Relocation of equlpenertt ped'wfil result In addrdaetal cost to owner.
N;)TE: RA pool immedia* attar pluter (foWw h=x 1km). Do nd use rubber hose.
N'.ITF' Do not turn on pool Wt when pool Is empty. -
0 H Wet down concrete MH at beat twice daffy for sum days.dW WmA is k ztalled.
1 f .ave reviewed this plan and hereby approve total plan &
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FOUL SD+ x
surtm AAA. -X->
p
EtCAYI[110N Accm .
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Dig From [yam ` :ASC=
0b=mjes
Wags Removed .
Repbced_
Misr
PLUMBAiG Fater
Pumper t .: 1 skm
Boosirr Ptanp
Sidm Run (Rain Drain
Ret
FFJ Um yt% Purifier :
f -s (-{—
Auto Qeaair `-r AQ;1 " Z
Htr T� Sia `~ Lt
Gas Uf—d
FOUNT01 FRAY HDS— WATER EFFECTS
Type
size
ftrn >;nq txVM
_
Booster Yssft Type -------:---Sae
Misr --
STEEL GUNITE Eng ?� a
Sw-d�uye.
6 R88 3T 18'
246
Step Risers
spa Wall Wfdtn
Bendtes
Lave Seats ��
Spa Dam WaB -
Match
mISG
ELECTRIC Total Run UFS
Remote
FiOerOpgc _ -
Spa
Wsc.
TILE WA kW
Coping . I
Step A Beach TW _
.
r
DECK M6 Sq R ^ Type
_ Color
flat Cantles Sq R Cantilever
0.0.0.OF _ hep Risers
Mlsc.
'
SPA Size 'Z a Area Par
Pump Blower slur
Jets step UOQ._.
>;
1NTE M FINISH
Dew
OWNER � [�-rlr
ADDRESS.
UTY y ��LD SY S DATE—IL
PHONE (Hy
DRAWN BY--.. DATE --