9711-008 (RPL)LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT# CONTROL#
H'4 I i hereby affirm under penalty of perjury that I am licensed under provisions of
Cha��ter 9 commencin with Section 7000 of Division 3 of the Business and ��7,-3 2 3 9
•;r ( g ) DATE VALUATION LOT TRACT _
N W Professionals Code, and my License is in full force and effect. •'Ji•3,G7•INi
� License # Lic. Class Exp. Date
OW +7211, l A $!i �� ADDRESS 45��,551)>-,.%E, Z�'.ii4t ///E V APN
��G�
0 Z vDate � Signature of Contractor OWNER CONTRACTOR/DESIGNER/ENGINEER
CD 0 � H C:) OWNER -BUILDER DECLARATION 13'01?` Z P SSI,;Ct,A"n:�+ - g; :a5. ! i}�3V; fJ$f
J V i. S S 5. 1i. s'I' i3 -U11 MAJIrf'i't Y ul+i_ S Did VC, S°M. F4
W W I hereby affirm under penalty of perjury that.) am exempt from the Contractor's
~ a- License Law for the following reason: PA1F.,N3. DIE'S C CA. 9220 DI -1.10.101 CA i-Yi260
Z ( ) I, as owner of the property, or my employees with wages as their sole (7601.146-4012 CRIA 10411
compensation, will do the work, and the structure is not intended or offered for
sale (Sec.. 7044, Business & Professionals Code). USE OF PERMIT
. ( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals K10L
Code).
( ) I am exempt under Section B&P.C. for this reason PCK.IL. A NTJ SIP OiNLY
LO
N Date Signature of Owner -
O, rn
(L, Q WORKER'S COMPENSATION DECLARATION
oI hereby affirm under penalty of perjury one of the following declarations:
Lo < O O 1 have and will maintain a certificate of consent to self -insure for workers' V\001, r6NIX01Z SPA. i�,6$7.t)L 111,
X W ` IL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
co Q U o� 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
li � Z permit is issued. My workers' compensation insurance carrier, & policy no: are:
Carrier- y Policy No.
.1) any •
Q (This section need not be completed if the permit valuation is for $100.00 or less). 'MUMUFEE
I certify that in the performance of the work for which this permit is issued, FLAN C=i~#,:C`Lti. FEE 16 i-CiN-4'39-3199.4
I shall not employ any person in any manner so as to become subject to the10) op -41.X -4)N1 $151.cm
workers' compensation laws of California, and agree that if I should become Nil 11AMC".uafs--'1.'C 011T., I()s-()��-42.1.000 24.01
subject to the workers' compensation,provisions of Section 3700 of the Labor , .
Code, I shall forthwith comply with those provislops. 'f � k i� t�tiT STEL^ "' �' 161`0W-420.000 '�S,i.0,
vbate: //"fi,' �i Applicant PL11Wt3lt�IT. 1, E -- i.(,X . 10.1 -000 -419 -ULA $'li.Ftll
Warning: Failure to secure Workers' Compensa Ion 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 r , ` , .
k� y T{ A1, f;t':i?•i,KIRT TA,110N AIN _0 P4,t\'•�f (,i-1jC Y, $3419AS
any permit issued as a result of this applicaton agrees to, & shall, indemnify ,..,. ° - }
& hold harmless the City of La Quinta, its officers, agents and employees. �9 �'°"' 1'.:. ,i�r; i FEES "'t 00
2. Any permit issued as a result of this application becomes null and void if -
work is not commenced within 180 days. from date of issuance of such NOV 0 6 1997 I" 1imV,1Yx.9+.cvsOt.fcNOW ,';)$t.45
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
�_YITV 01F Lfw` j 030 j fi I
construction, and hereby authorize representatives of this City to enter upon i
the above-mentioned property'for inspection purposes.
RECEIPT DATE BY J DATE FINALED INSPECTOR
/Signature (Owner/Agent)!/�='�� Date L� f
S
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
Neater 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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole,
Underground Conduit
Rough Wiring
LowVottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
W
LICENSED CONTRACTOR DECLARATION
IYereby 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
574127. A
Date Signature of Contractor
OWNER -BUILDER DECLARATION
8131/99
I hereby affirm under penalty of perjury 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
I hereby affirmunder 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. Policy No.
Sf A'i . I+`Utm I V 12 679-97
(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 thispermit, 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 those provisions.
Date: Applicant
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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDINGPERMIT PERMIT# COpNNT,ROL## ..
DATE VALUATION LOT 9711!-008 TRACT d Z 1 O
111 G97 $13,687.00
JOB SITE
APN
ADDRESS
45-1 OF-SER:f VWW COURT
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TOPAZ ASSOCTiff S
STEVE DODSON CONs1'RUL'rm
om Sri. "13" S'!'1'tPE r, S(` . #200
73-011 COUNTRY CLUB DRIVE, S17i . Fa
SAN BER.NARDINO CA 92404
PALM DESERT CA 92260
(760)346-4032 CBLf# 1044
USE OF PERMIT
POOL
POOL AN -D SPA ONLY
POOL ANDYOR SPA 13,687,00 LS
-•
11
-
E, STIMA7TED CCKST OF CONSTR'UCT ION
D 3,ti83.3111 .
tl
PERMIT FEE SUMMARY
n �,
PLAN CHECK FIT 101.-000.439-3.18 $99.45
CONSTRUCT.INN 1"E;E 101-000-418-000 $153.00
`
111 HANiCAL'Flt--POOL• .' 1.01-000-421-000 $24-00
6L15C'rRICAL FEE --POOL 101-000-420-000 $45.00
j' !
PLIAV031NG FM- POOL 10.1-000419-000 $27.00
,
SLTB-IMAL C:'ONSTRUCT10N AND PLAIN atEC K
$348:45
�I
(j
LESS PRL -PAID FEES
Wou
(j
TCVrAL PEfttl .1T FEES DUEN0IV
$3dt3.45
, HI
RECEIPT
DATE
BY
DATE FIN LED
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain,
Bond Beam
Approval to Cover
Equipment Location
f
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 y
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I. •
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: