9601-016 (RPL)LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
(n _
oLU Section 7000) of D'Iv.ision 3 of the Business and Professionals Code, and my
n Q � License is in full force and effect. 348761+ C Y3
nW License # Lic. Class Date, .
Z- Z � /Date - 2 6 SignatureofContractor / .� • rs.�
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H OWNER -BUILDER DECLARATION
J W 1 hereby affirm that I am exempt from the Contractor's License Law for the
2 following reason:
Z ( ) 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
C0 Date Signature of Owner
LO
N.
rn WORKER'S COMPENSATION DECLARATION
CL Q 1 hereby affirm under penalty of perjury one of the following declarations:
E Z () I have and will maintain a certificate of consent to self -insure for workers'
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9 0 compensation, as provided for by Section 3700 of the Labor Code, for the
X W 0 performance of the work for which this permit is issued.
p 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 '1_4
illar�r rD Policy No, rr,0 n oh
It (This section need not be completed if the permit valuation is for $100.00 or less).
�
:D () 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 tho. rrovisiotns.
Date: �' ��" Applicant We
. 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 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 property for inspection purposes*.
Signature (Owner/Agent) 450,+x'f'" -'� � ,'° Date
ALC S
BUILDING PERMIT '
PERMIT��¢)� 0�if
DATE
VALUATION $�(�(
LOT
TRACT
JOB SITE ADDRESS
APN
45-540 DESERT AIRE
OWNER
CONTRACTOR
WESTERN FOOLS
ROBERT LOWF LL
43375 MADISON ST
45-540 DESERT AIRE
I IND1O CA 92202
.LA QUINTA CA 92253
(61.9)347-5959 CRL# 1151
DESIGNER/ENGINEER
USE OFPERMITIOC— R[bD�0- SPA
POOL AND SPA. ONLY
z
FEE DESCRIPTION
FEES
POOL ANWOR sPA. 15.GW.00 LS
ESTIMATED COST OF CONSTRUCTION
><5,�ai.(►0
PERMIT FEE SiJ11 M..ARY ,
'PLAN CH:1 MX EEE 101-000-439-318 $105.30
CONSTRUCTION FEE 101-000-418-000
WCHANICAL F0,, -- POOL 101;-W-421-000 $24.00
ELECTMICAL FIZE --. POOL 1.01-000-420-000 $t9.uQ
PLUMBfNG FEE -- POOL 101-000419-000 Sa7.00
SUB -TOTAL., CONSTRUCTION.,"D PLAN CHECK
063.30
LESS PRE-RAIDPEES
$0.00
TAT, PERMIT FEES 1711E NOW
DqPE
$363.30
I� a
QN
41996
e
RECEIPT
BV
DATE FINALED
INSPECTOR
INSPECTION RECON®
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set racks
Fom1s & Footings
Slab Grade
Stei;-
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
nniwall _ Int 1 ath
OPERATION DATE 1 INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover Ir
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation .24143 la
Gas Piping
Gas Test
Appliances
Final 1'
COMMENTS:
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