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LICENSED CONTRACTOR DECLARATION
I hj reby 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 #t ! r--. Lic. Class Exp. Date
556230 C532/28199
Date ? - I Signature of Contractor q
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 wor0and 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 Policy No.
STATF FUNI) I1Z10 V-96
(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 pr visions of Section 3700 of the Labor
Code, 1 shall forthwi comply with thos7provisil s.
Date: f*! l Applicant tri
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 persomat
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 n
correct. I agree to comply with all City and State laws relating to the building�C
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property foo insction purposes.
C,
Signature (Owner/Agent) Date
Z
NNTTROL#
BUILDING PERMIT PERMIT# CO6150
DATE VALUATION LOT d.. l�1TF-10S TRACT V 1, 5 0
S151500.00
JOB SITE
APN
ADDRESS
4.5®21b-r�-RT°i EW CGURT
OWNER
CONTRACTOR / DESIGNER / ENGINEER
EG0EBRA ATEN
SUNRISE POOLS
45-215 DESERT' VIEW COURT
44028 ELKHORN TR.
LA QUINTA CA 92253
PAL1N DESERT CA 92260
(760)3,10-5521 CK4 100.4
USE OF PERMIT
u t
POOL AND SPA ONLY
POOL ANU;OR SPA 15,3(110.1 LS
ESiTINIATED CONI'OF (:ONSTitU i'fON
15,51M1.1tt!
PERMIT FEE SUMMARY
PLAN C iCK FFE 101-000-439-3)8 Sli1.1.5
CONSTRUCTION FEE 101-000-118-004 s1�1.�x1
MEC"EiANICAL FEE -- POOL 101-000-421-000 a24.00
FJAX-1'PJCAL FEE .-- KXX 101-040-420.000 545.60
PIA MRING FER - POOL 101.440-119-400 $2700
SLIB-11YIAL CONSiRU(MON AND PLAN CHECK
$378.15
LESS PRE -PAID VERS
1+0.1)1)
`
6
TOTAL PERMIT FEES DUE NOW
5.178.15
31 1997
K
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
a
,
ANSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Ba ,
Underground Ducts
Forms Footings
Ducts
Slab G+-ade
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
BLOCKWfALL APPROVALS
Steel
POOLS • SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground ectric
Underground t
/ S
Final
Gas Pi ing
PLUMBING APPROVALSas
Test
Electric Final
s
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover -
I
Sewer Connection
Encapsulation_
I
Gas Piping
1
Gas Test
Appliances
I
Final
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)
COMMENTS:
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