0302-188 (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 # t ii �9 aLic. Class Exp. Date //9st
53 fir
Date-�*dN' Signature of Contractory�
r
OWN ER-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 (Seca 7044, Business & Professionals
C. do).
( ) 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 t40 C.OPF'I` Y Policy No. iCO+(A3W-2. 00
(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 with those provisions.
Date: 1A / %' Applicant '' - _ -+'0� 12
�.f,...�. � .. �, ✓ ;• f ' ,ate,,.{' .-c ' � � .......-
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employepto 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 have readthis 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,t�his City to enter upon
the above-mentioned property fo inspection purposes. d d.
4 f1 ,r
Signature (Owner/Agent) NF � Date ---� •�'=�'''�
� I
P� » 't' PERMIT#
f
BUILDING PERMIT
t3."°sC92-X,S8-
'LOT TRACTJOB
DATE_ it .. VALUATION =4,000.00
SITE
ADDRESS ^ SR)MIN Z %l
I
APN
...
OWNER�
CONT�.FRtyAg3.CCT`..�OR�
E.i;N
ML(LiNJAMoy
�DESIGNER
kPNN.L"EMVEER
�gJ•J�ly / q �5
78.870.'Ti MIRTH WAY,
5'70 OM. VWXi,RD
1'JA QT)DrfA CS 922-53
PlilRM SPRUGS CA 0,1263
('760):24,583 t C'Sle 971
USE OF PERMIT
POOL 4ZWOR ��.fk
f'i7CJS�`dJt h..t' W41&MMV!Ii,tal21i;1]"»RB Cti°kr1 b It .IN r,11JA105.f Alp rR.rJ fl'W%IJ`) 050 '
t
POOL 44DICIR NPA AMIN U,
USTIMATM COST Or, COAXYRDM00
IrIRM�A;i?'is°Ta: UTT3T11TMA]I Y
pidw C HW.F. FEE 10) -000-M-3 18 $I52.10-
C0NS _R,U(`!K')N MO.', $MIA.0)
NIEC'F£MICA-1. VIM— POOd, $24.60
:E ECTEU ;.I. M, -9 POOL 101.000-420-_000
PLUME11NO FIM POOL 101-000-419,fN* $460
;t
r
•Ar„
SUB -TOTAL _'AND P"t.i?,Tt CIC
$482.10
FEB 2 7 2003
CITy () LA QUINTA
FINANCE DEPT.
RECEIPT„DATE
+'
BY ''
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
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
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:
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
4 1055 C53 yIR , 01J: i/;1f
Date 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).
( ) 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 !�l,v`ft ��1;1 Policy No. d9nsTi3Jt?
(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 with those provisions.
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.
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
BUILDING PERMIT. PERMIT"
DATE VALUATION LOT 03021488. TRACT
JOB SITEAPN
�Z
ADDRESS O Z � UR W. -AY
OWNER CONTRACTOR/DESIGNER/ENGINEER
C""OLT'A -TAW1;Wk
7 9-87 0 21NIM : WAY
XA QUfl TA
I USE OF PERMIT -
P001 -AND/OR SPA
RI�Y�.' 1PARZNWI f � OOT S t,.'tve''N:3''.I'�°'.-+t.rt"iM
CIA 92253 _ PAT..M S;PR'1;NGS CA 9'263
,1 4)324.5£827 C:f3I ## 912
PCIOUSPAL AIARMWM. ARIX'S SHALL SN; Of PLACF./ T Plt&PLAS('Z42+.
INSPECTION,
I-
ES-1WAM CONT OF C-0KNURUC-1-700
P1.,A,N aw"K FE.4? 101.000-439.318 W2.10
CONSTRUCTION "Is 101-000-418-000 $234,00
MECHANtM RE --POOL 101-000-4 1.000 524100
F,LITUR'SICAL ME . POO!, 101 _000420-000 $45.46
'PLU10ANO FEE. -- POOL 101,0004,19-000 WIN
SUS -.(.CTAT, iri4„ NITM a/CTTOR AND PLAN CHO=
RECEIPT I DATE I BY
�-_IsO wz
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
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
6
COMMENTS:
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)
J
..................................... ........................ 90 ft.
+18" CD 3- 2' Sheer descents
Ml
42 ft.
��3 o ft
DOft.
18 ft.04
V.
v, I 1!,t I
q -
C)
=3
.......... . ...... . . ......... . . . . . ......... .
.......... . .........
A
Salt finish concrete
CITY OF LA QUINTA
BUILDING & SAFEW DEPT.
APPROVED
Job
Specifications
Pool Area
553
Pool Perimeter
115
Shallow Depth
Deep Depth
Spa Area
Spa Perimeter
Face Tile
Coping
Deck Area
1271
Deck Perimeter
309
Patio Area
Patio Perimeter
Pool to Equip
Spa to Equip
Rich Parzinsky's Pool Construction #431055 Designed by: Caroyln Janhke
P.O. Box 897 Phone: (760) 324-5827 Steve P. Designed 78-870 Zenith
Palm Springs CA 92263 Fax: (760) 324-7287 2/24/2003 for: LQ CA