0305-220 (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 d
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
{7 1104
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 theirrsole
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 Uwner
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
5'TX% RAND 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 California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
C�Oe;'I shall,forthwith comply with those provisions.
(, aApplicant
Date:
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
fr r
PERMIT #
LTJ RMIT 4��i2o
DATE VALUATION 4;;��i,�hY� f' LOT TRACT .
JOB SITE S6,,*Z7 VVfPfcm k'0 U'
ADDRESS
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OWNER
CONTRACTOR / DESIGNER / EN (NEER
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(vMIy)`78•1700 tIkiIA 14951
USE OF PERMIT
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POOL ANDOOH SPA
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itV Y1}`{\€a 101 100
:;Crjw w'1`1t 13 •' Og ? "u'•6' 1()1-000-41 &.000 4,352.00
ArlEf.,T")i-W.tLaF,f..ME P� 117£, 1011 ("1)0•471^(D()0 $24,00
R3.fi', "2't:tlCA E.* ? .. 'K', 0Ll 7 O i-000-42,0 000
mvw,two nR •- pecxj±, -0 10,419.000
SUB -TOTAL CORISTlIM111 1114 AM CTIECK
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RECEIPT
DATE
BY ,
DAT�I LE
INSP5W5RL
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 6 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 8 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
Unde
Final
PLUMBING APPROVALS
s Piping
G est
Electric Fina
Waste Lines
Heater Final
Water,piping
Plumbing Final
'lumb' g Top Out
Equipment Enclosure
her sans
O.K for Finish Plaster
ateral
Pool Cover
- Connection
Encapsulation
,Ping
A test
.Janes
Final
p
c
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:
BUILDINGI
INSPE
777-7153'kpr,
BILL & JOANETTE GRAVES
Owner -
Contractor
CANYON VIEW POOLS
Permit Number 0305-220
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 56-027 WINGED FOOT
POOL/SPA.' ALARMS/BARRIERS SHALL BE IN PLACE AT PRE -
PLASTER INSPECTION. EQUIPMENT ENCLOSURE NOT
INCLUDED/REPLACEMENT JOB CARD:':, .
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE -.
U/G ELECTRICAL / GROUNDING '
FOOTINGS / STEEL
CONCRETE SLAB.
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC"~ r w
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECT1019S
FOOTINGS / STEEL -
/ O
BOND BEAM
03 G
POOL-/ SPA / WATER FEAT
INSPECTIO S
PRE-GUNITE / SETBACKS
U/G PLUMBING
i
U/G GAS
U/G ELECTRICAL
PRE -PLASTER (ALARMS/ BARRIERS
'FINAL INSPEC
z 3
ION
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
a
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
A RE -INSPECTION FEE OF D
WILL RECHARGED IFTHE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR q SCHEDULED
INSPECTION.'
NO EXCEPTIONS!