0206-083 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that.lamlicensed, under provisions of
Chapter 9 (commencing with Section 7000) ofd.Division3'sofof a Business and
Professionals Code, and my License is in full force and effect:
License # Lic. Class yah%Axp. Date
.�y656128 C53 HTIC � # ��: itif�lilIt
Date 1--l-- Signature of Contractor
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). `'q
( ) 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 t 'I' xlC0MpEHJA'�"I'1 Policy No. t lo$�3 � 4I
(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,provisions of Section 3700 of the Labor
Code, I shall forthwith comply wit Rhose provisioyrs.����
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. Y
1. Each person upon whose behalf thisapplication 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*i6 application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for180 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 auth'orVe representatives of this City to enter upon
the above-mentioned property for inspection pur:;y
,+�'�i Signature (Owner/Agent), I I ADate "
BUILDING PERMIT PERMIT#
DATE r ti .y
VALUATION1t LOTS TRACTJOB
Y,
SITE
ADDRESS '9`•9,RiS DOUBLEEAGLEAPN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
WAi KU
CANFORN—LkPOOLS e SPAS CWP WIT CO
. ..'79-9135 TX011LEjsAO11s'
7 725 JOKIDRIVE, 1�'C7I SE Gly.
Lk Qili TTJ A, CA 92253
PAIIA ILRI.1R1 CA 92260
4-
,760)340-9113,00 tv13I �o35t
'
USE OF PERMIT
POOL A'A fOR. SRA
317A ADDITION TO UISTi"N0 T'f30L PR9.riLiGIN MED i?LAN Atli B11Q
Z21 -X9'•1995 AL-ARMISIDAI't«RMS SHAtZ BE IN PI.&CE PRIOR TO
4°R&PLASTEP INSM TIiDK
.pOl'.LANUOR ISP : i -21 00P.00 W
ENTMNEED CWT OF COPS TR`UC IT01Y
121WO.W
rywirr FEE SUMMARY
PWI I3%CIlK FFIZ 103-000-439-319 9",,7S
CODS r Ru ,'I` ill ME 1011.700th-€'1 b-�'t,0I3 �u'I aS.►1ft
CHANIC'A FU --;BOOL 101400.421.000
91 EC'TRICAL R'f:E — POOL 1 101?, 00420-000 X5.00
PLUWWWO VEZ_ P0011". 101-00041.9-000
i i~l(TA
u
U 1a�u1
CITY OF LAQUINTA
'
.+c�yps� Y+�q f�pypyry,,�1y alp 7 y�pF,I�Nt�AyyNCED{�.E,PT_1
. tJ ^ SiJ�.4 ['iL. i,�:L,i67 i:Y ld C.: ,i�✓.L'V �Y13'-��d 'l.l %S�1 �7, 'x ` •••
q
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3 F' r ovm I''MUT V=9 oum SO'tfli-
RECEIPT
DATE
BY £
DAT I L,ED INS- O
1t
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
-
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
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
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)
Final
COMMENTS:
-
1 ,
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PATRELL
ENGINEERING
GROUP, INC. _
651 E. Northridge Ave. Glendora, CA 91741 - PH: (626) 335-4362 FAX: (626) 963-4812
ENGINEERING CALCULATIONS
AND DETAILS FOR
BUILDING SURCHARGED. SPA WALL.
KUHNE RESIDENCE
79-935 DAMDEtKWDR.
LA QUINTA, CA,.
CIO J 9�
p 2
w No. .2934 m
rExp. 6/06 .
DATE: MAY 30, 2002
ENGINEER: DOUGLAS R. FERRELL
RCE # 32994, CALIFORNIA
651 E. NORTHRIDGE AVE.
GLENDORA, CA 91741
(626) 335-4362
t ooU WAk-L 1TO IE>C- PEs«rlGo To
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PATRELL
ENGINEERING Client: G s
GROUP, INC. Engineer:�-c�-
651 E. Northridge Ave. PH: (818) '335-4362
Glendora, CA'.91'741 FAX: (8'18) 963=4812 Date: 30 0L Sheen of
�A
Project:
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ENGINEERING client:
GROUP, INC Engineer:
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651 E. Northridge Ave. PH: (818) 335-4362
-L' Sheet . f
Glendora, CA 91741 FAX:. (818) 963-4 O
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ENGINEERING
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65.1 E: Northridge Ave. PH: (818) 335-4362
Glendora, CA 91740 FAX: (818) 963-4812 Date: Sheet of
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