9710-085 (RPL)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter Pc (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O =) ch Licenses# Lic. Class Exp. Date
SOLO
LLJ
'� �•55�+?3G C�3 / 2/28,199
o Z Date ���- ?� 4 `L Signature of Contractor'L+
7—
(Do
J U C:) OWNER -BUILDER DECLARATION
W LULU r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z ( ) 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) .1 am exempt under Section , B&P.C. for this reason
L
O N Date Signature of Owner
rn
a Q WORKER'S COMPENSATION DECLARATION
o CrI hereby affirm under penalty of perjury one of the following declarations:
O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q C.) ( ) I have and will maintain workers' compensation insurance, as required by
O U' Q Section 3700 of the Labor Code, for the performance of the work for which this
d 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
co
O NTATF, FUND 1210734-96
J
(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 gree that if I should become
1 subject to the workers' compensation pro Isiontof Section 3700 of the Labor
•\••77 Code, I shat forthwith comply with those Iov �ionst
Date:' U" 1-(/ Applicant )f
o
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, end State laws relating to the building
construction, and hereby autho ze repiJesentatives of this City to enter upon
the above-mentioned propertyldr inspection purposes.
01 -
Signature
Signature (Owner/Agent) Date
.Q
BUILDING PERMIT PERMIT# CONTROL#'
DATE VALUATION LOT_ %1O -TOSS ' TRACT 14
$14,300.00
JOB SITE
APN
ADDRESS
491O' _FSE FW -1w
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RODRIGUEZ
SUNRISE POOLS
45-150 DESERT VIEW
44028 ELKHORN TR.
LA QUIN'T.A1 CA 92253
PALM DESERT CA 92260
(760)340-5521 C bL4 104
USE OF PERMIT
v 7
POOL AND SPA ONLY
POOL AMD/OR SPA 14,A10.00 LS
IESTIMATED COST OF CONSTHM ION
i;,3Cf3D.1111
PERMIT FEE SUMMARY
PLAN f.'11E'CK .FEE 101-000-439.3.18 8105.30
CONSTRUCTION FEE 101-000-41."00 3162.00
MECHANICAL VES -- POOL 101-000-421-000 524.00
ELEC'MICAL ":H — POOL 101-000-420-000 545.09
P.LUNfB1NG FEE -- POOL 101 -000 -419 -OM $27.00
h
t
SUB -TML CONSTRUCnON AND PLAN CHECK
$363.30
M LASS PKE-P.A11)1.,ELS
50.00
TOTAL PERMIT FEES DUE NOW
$363.30.
OCT 31 1997
RECEIPT, 6 l.-;
DATE,
BY
DATE FINALED
INSPECTOR
,i
INSPECTION RECORD
,i
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR'
j
_W BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
1
Slab Grade
Return Air
i
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
i
Fireplace T.O.
Fans & Controls
1
Party Wall Insulation
Condensate Lines
Party Wall Firewall
i
Exterior Lath
Drywall - Int. Lath
t
Final
�I
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location—_
Undergroun 0
Underground Plbg. Test /
Final
Gas
PLUMBING APPROVALS
as Test it
mal
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:
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
F' ;g
Temp. Use of Power
- t
Final
'?A
Utility Notice (Perm)