0206-055 (RPL)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.
License # Lic. Class Exp. Date
061 8 C53 19C C
bate !( . r Signature of Contractor ti ,
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).
( ) 1, 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
LIM blgnature or 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.
()4) 1 have and will maintain workers' compensation insurance, as required by
Stiction 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 STATE C.' 0MVIENS•ATI Policy No. 046DO0 168-01
(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 Sectio 3700 of the Labor
Code, I shall forthwith complycanwith thoge �ro tons.
Date: A`.r- 1 y f17 Applit �J Z
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil finesup t $ 0,000, ir��,,
addition to the cost of compensation, damages as provided for in ion 370 -,
of the Labor Code, interest and attorney's fees. lu
IMPORTANT Application is hereby made to the Director of Buildi n Safpt1%
for a permit subject to the conditions and restrictions set h on •FSS'
application. -er. r
1. Each person upon whose behalf this application is made & ea h persosN
whose request and for whose benefit work is performed under o
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 irispectionn purposes.
Signature (Owner/Agent) e� ' y"' Date&`�'�-2s
BUILDING PERMIT PERMIT#
DATE ) VALUATION 42.()1t30C3.00 LOT TRACT
JOB SITE APN
ADDRESS 54-715 WWGIED FOO`
OWNER CONTRACTOR / DESIGNER / EN INEER
NI/tUl r'AYIFO:E;2.`KIA 3:001.9 & VAS (r -M ' .WIT CO
54.7 15 i7JWOM) FOW 747 25 JOI'n: nMV7M 5= OA
LA QUIN TA CA .92239 P.A;..0 I.aliSM CA 9.2260
(780)340^91MO CIA 00355
USE OF PERMIT
POOLAN`SPA. 5BQZ21-&-1995. N.tZiI T 496�tCAL. 'VAULT PER
SIRIYiRD CPViATIOpry, 17hAAR;.3/0M1UUERS UHlLLo ik f llT K•
PRIOR TO P11" L,ASTER.1Td3PZ_-TIO1,L POOL EQUTt M04T ENCLOSURE r 1,V t t
Pt~)OLA.NL DOR, OFA,
79,400100 LS
X9MIAAM CONT OF t:OK5"RUCE10
r
3'1m CHECK nZ 101.000.439-318 X134,53
C; INS°1RUC,Y'1fAPt FLEE 101-000-418.000 $207.00
MECHANIC.".AL 'FFE. -- P001, 101-000-421-000 $TUD
EL1*C"7'1UCAL F 10, .• POOL 1 Ox -000-42.0.000 $45.00
PlIU z MING FEE . POOL 101.000-419-000 127.00
13 2002
LAQOIRM
ACE13EPT ids -TOTAL C.C72dM'[TC:`1'xMI ANDP?;rA:l'afMCK $437•35
T
30 P:�. -TIAW F >
•s
I"C) AL PXRMT FZEN DIM NOW w7m
RECEIPT DATE j BY J DAI h ALtU irvWrtci
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
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
_
Final
Underground Plbg. Test
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
Sewer Connection
Gas Piping
Pool Cover
Encapsulation
Gas Test
Appliances
Final
IN
0
S\jy\-r -PR Alt -i -Ta
CALIFORNIA POOLS
OF THE
COACHELLA VALLEY
74725 JONI DR. #A
PALM DESERT, CA 92280
w
f-ITY ®FLA QUINTA
;-qN,!G & SAFETY DEPT-
-WED
'cTION
LDAI
kaUIPMENT VAULT
X 211, jC>-2q -
-1
JTS
STRUCTURAL CALCULATIONS
A UTILITY VAULT
2 RINGS 5X8X3 AND COVER
Prepared for
COACHELLA VALLEY SEWER MATERIALS
BY
YOUNG ENGINEERING SERVICES
November 29, 2001
CITY OF LA QUINTA
BUILDING & SAFETY DEPT;
APPROVED
FOR CONSTRUCTION
DA �/O BY
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,qOTES:
ALL iREBAR TO BE #4
VERTICAL BARS ® APPROX. 11" O,C,
CONCRETE TO BE RATEDPROX AT IiW PSI, M{N.
000 t
4" THICK
CONC. WALLS //./•
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14•
6" THICK
CONCRETE
I #4 REBAR \
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UTILITY VAULT
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