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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. moi'
L'cerise # Lic. Class, Exp. Date
Date Signature of Contractot' ' -
OWNER -BUILDER DECLARATION
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 affirm under penalty of perjury one of the*4following 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 1XEMlaT 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 CalCia, and"gree that if I should become
subject to the workers' compensation provisi6nsfof Section 3700 of the Labor
aC de, II h6ll forthwith comply wit�'i erp,rovisions.
te:J 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
inins%pection purposes.
Signature (Owner/Agent),/ Z Dafe' f�
BUILDING PERMIT PERMITp
DATE VALUATION LOT 00OS-097 TRACT
Stopw.UU
JOB SITE
ADDRESS 79-m DC��I�. w u
APN
-
OWNER
CONTRACTOR / DESIGNER / EN (NEER
VAI 'W,
VAT UY POOL &IPPA
79185 MWE DRIVE
4741 C & PATIUA CANYON DR, #116
tA.(2t1W,CA CA 92253
PALA/! SPPWGS CA 92264
(760)778-3939 CBL# 3.565
USE OF PERMIT
POOL AMM SPA.
POOL $ SPA ONLY - ALA12MS %BARRIERS SMALL BZ IN PLACE AT
PRE -PLASTER INSPECTION'. INCLUDES IS LF, OF BLOCK WALL AT 3'
HIGH
VALUATION 10,000.00 LS
ES1.1ragm COST OF CONSIM'(Myr3ion
10,0W.00
PF_R W r F"? 9 ETKWARY
PLAN CHECK FRE 10') -000.439-<318 8`XIVIS
CONSTRUCTION FEE 101-000418-000 $117.00
MECHANICAL FEIN -- POOL 101-000-421.000 $24,00
ELECTRICAL FEE -- POOL 1,01-000-420-000 $45.00
PLUMBINO FEE -- POOT. 101.000.419000
:IM-110TAL. CONSTRTIMIOI+i AND PLAN CYM,("'E
$289.05
LWS PRE PAID FMS
S-0.00
TOTAL PF, -RW -'f FENS DUE NOW
$289
RECEIPT
DATE / BY f
DATE FINALED
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
Steel
POOLS - SPAS
Set Backs
Footings
Electric Bond
Main Drain
.L
~
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
t i,
Underground Plbg. Test
CO , y
Final
Gas Piping
C
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Fina4
Water Piping
Plumbirig'Ftt4f,..
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Z -13-00 Llx
i3 -
Gas Piping
Gas
Gas Test
Appliances
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:
y
MAY -07-00 07:13 AM NHF CASTORENA
760 772 5860 P.02
N
City of Ls Quints .
UNdinp R Safety. Division
P.0 -Box 1'504
�► '
78-49S Cale Tampko
La Qulnta, U 9203.
:.8uliding. Permit Appitpdon and Trackin 'Sheet'',
Pwl!w Address. 79185 DIANE OR
Ownk l Name- VALENCIA
A. P. N%unhcr,
Address: 79185 DIANE DR
LcPal i)ekriptirsn'
C*ry T-.4, LAQVINTA,
t:t+ntra:-I;t. VALLEY POOL & SPA
?<
GUNIT
rWttrcy� 4741C E. PALM CANYON DR
..._..., ...�......_
#.116 Pnttriq�r�yil�t►, POOL
04t .5','. t,P. PALM SPRINGS, CA
Tcicph,}Ifr: 778-3939
i4wre1,C53-721005
CityLu.M -2565
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MAY -07-00 07:16 AM NHF CASTORENA 760 772 5860 P.04
CITY OF LA QUINTA
SUR-LIST
CONTRACTOit_VALLEY POOL & SPA ADDRESS 4741C E. PALM CANYON DR
OWNER VALENCI JOB ADDRESS 79185 N
This fom► shag be pgated on the job wlth tfle Building Insp Aon Card at all threes In a cerLnlemu Ua s.
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub-contrectorOhat
are on this list are the same persons performing the work. Any changes to this list must be approved the
City of La Quints Department of Building & Safety gds to work being performed by a changed sub-
contractor. Failure to comply will result ins stoppage of work and/or the voidance of building permit.
TRADE
SUB -CONTRACTOR'S
NAME
TYPE OF
LICENSE
STATE .
CONTRACTOR'S
LICENSE
NUMISER
WORKER'S
COMP. .W ME/
NUMBER ON FILE
ct"
BUSINE88
LICENSE
IOJMBM/
bW. OATE.
GRADE/
EXCAVATE
GATTUSO POOL
A/C -12
672850
6/30/01'
2004498 01
1/1/00
816
1/12/00
PIPELINES
C-34
CONCREM
FOUNDATIONS
N/A
C 8
ASPHALT
A
FRAMING
B
STEEL/
STRUCTURAL
C-51
MASONRY
C-29
PLUMBING
GATTUSO POOL
C•38
67285
816A
LATHING
C-26
DRYWALL
C-9
PLASTERING
CROWN POOL PLASTERNG
C-38
9/30/00
8/7/98
HVAC
C-20
ELECTRICAL
GATTUSO POOL
C-10
67285
816
ROOFING
C•39
SHEET METAL
C-43
FLOORING
C-16
GLASS/
GLAZING
C-17
RSULATION
C-2 .
UWAGE DISP.
C-42
PAINTING/
DECORATING
C-33
TILE
C-64
CABINETS)
INSTALLATION
C-8
FENCING
C•13
LANDSCAPING
C-27
POOLS
C-53
OTHER
J & L GUNITE
472187
FrOADWIN500
794004,20101 2/A
9/19/00
MAY -07-00 07:12 AM NHF CASTORENA 760 772 5860 P-01
CITY OF LA QUINTA
UB -LIST
CONTRACTOR_ VALLEY POOL & SPA ADDRESS 4741C E. PALM CANYON DR
OWNER VALENCI JOB ADDRESS 79185
This form shall be aosted an tha job with the Buildingk+
Insp�d ardat al times In a gonsoleu us place.
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that
are on this list are the same persons performing the work. Any changes to this list must be approved the
City of La Quints Department of Building & Safety p!jQr to work being performed by a changed sub-
contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit.
TRADE
SUB -CONTRACTOR'S
NAME
TYPE OF
LICENSE
STATE .'
CONTRACTOR'S :
LICENSE
NUMBER
WORKER'S
COMP. NAME!
NUMBER ON FILE
City
BUSINESS
LICENSE
NUMBER/
W. DATE
GRADE/
EXCAVATE
GATTUSO POOL
A/C -12
672850
6/30/01
ZZEN 8 q6 7
1 /1 /00
816
1/12/00
PIPELINES
C-34
CONCRETE/
FOUNDATIONS
NIA
C-8
ASPHALT
A
FRAMING
e
STEEU
STRUCTURAL
C-51
MASONRY
C-29
PLUMBING
GATTUSO POOL
C-30
67285
816A
LATHING
C-26
DRYWALL
C-9
PLASTERING
GROWN POOL PLASTERING
C-36
42T6065
0
9
8/7/98
HVAC
C-20
ELECTRICAL
GATTUSO POOL
C-10
67285
816
ROOFING
C-39
SHEET METAL
C-43
FLOORING
C-15
GLASS/
GLAZING
C-17
INSULATION
C-2
SEWAGE DISP.
C-42
PAINTING/
DECORATING
C-33
TILE
C-54
CABWETS/
INSTALLATION
C-8
FENCING
C-13
LANDSCAPING
C-27
POOLS
C-53
OTHER
J & L GUNITE
472187
FREMONTINS 00
763 00 03
94
74/210//0
9/19/00