9601-112 (RPL)f LICENSED CONTRACTOR DECLARATION
Ihereby affirm 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. / )
jLicense ,# Lic!C�lass Date
Date.✓r _T. ignatureof Contractor ✓{ '"" ''�'"
OWNER -BUILDER DECLARATION
I hereby affirm 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
perfor ance of the work for which this permit is issued.
( 7have 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 Policy No.
(This section needof be completed if the permit valuation its for $1100.00 or less).
() I ce ify thtat i1 therh�tF
7performance of the work for whii s 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 prof. sions of Section 3�LXI of the Labor
Code, I shpJI forthwith comply, with those provisions.
Date: %„` Applicant
Warning: Failude to secure Workers' Compensation coverage is unlawful and shall
y subject en 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. ;
t
ZIMPORTANT 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 andlfoi whose Benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify'
& hold harmless the City of Indian Wells, 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 C” ,,to, nter upon the
above-mentioned property for inspection purposes: Y.
kSignature (Owner/Agent) ✓, Date X+
""'
BUILDING
PERMIT
PERMIT i"
ti�li9-91?
DATE
VALUATIONlOT
TRACT
JOB SITE ADDRESS
APN
4771145 E IA NICE '
OWNER
CONTRACTOR
c . SrE, VE DODSON CON -MU ON
CMMRY':HOMES COAKMUNITIJ!S
69805A. VERI-iZ RD. #E9
1535 /StJLMH D STRE V #200
l_.f1..['kfEDPLA.L CITY Gil 922,34 .
SAN:BI?RVATt.DIN, 4:A 92409
(619)324-•1.2.32 C8Ldt 10114
�Cr33 l .60p'jDESIGNER/ENGINEER
t
USE OF PER m1POOL.ANbifdk:SIRf1 .
POOL- AND :SPA
iuveiftp1. on Pee opplied for to n tlllt ssE ltstatCN.
FEE DESCRIPTION
FEES
-L°0iV'1RACT t\tlr OUN:C 159000.00 !,N
r
�;; may. �g y g+� g� �y'tv' a2 �g�g�pY�+ p� 7�
S'.i�iti7 1J.V',M, .��JI'.�iA.l'�4�J172 &�.OfS Si4.l�,.x��l�i.N
q nip
.' .9 }��Cl�/e
1?fk".RiV1I EV' SU:NIAI ARY
PLAN C`I1EC K FSE
!C:M-FR- UC.ri:ON FFY." V 101_000_4&_000 1fi2.0ti
— -
MECHANICAi:1"4.1+ - "'POO.I:, 101-000-42f-000 000 4.00
"ELLMRXCAL:['N�,-- POOL %.4)i 0(}11.40-fl(IQ $45.00
PLCtMB1NQ Fes+ . P100,1. 3231130
�
v7
ltiti LS1'.t.C,AC1C ��:1+`t MA )00_423400
m
CT:K
SUB -1110 AL CONISTRUC-nON AND PLANC1 fRILESS
�
7 S
RRE11-PA
4
0
TOT AL PERMYr ftx, S DUE NOV
$525JO'
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
. BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fortis & 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
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
CITY ®F LA QUINTA
* ` AI'ETY EPAIjTENTI� ��T>-
BUILDING & S , s •t _ a—, SKAP ____-__�� �
CONDITIONALLY _ty've--�
j 22�' ?4" �. �' � TFLE.CC�Ct2
"L:s.
•' i'`CALL Lt` is �f JZ,—
ACCEPTED FOP ,C ��r ' ' CP1N ; w
ct� f t77��•• �v �r n�
�'. p\�i S PER Jri �'ttAv AZT 1 v'C�'W CC4..CR _ - -
7
SUBJECT TO INSTALLf� i. ii�� n •�+� PER _ _ ►I spr :'4 AY FOOL
Qk� N 1- SF3 --- . "P Cf;PA4FT
i7TS ' MOTOR R HP 3'1A - 7�r
0"i
t ^\ 1 a1L?ER_ jTA 3�L> S{� FT
_I AND ALL APPLIChDLE Com'.°y 1V 'V '
€r -TER !v& 7 GFS
BY i SUC�•Ced _ItiESDATE J)
DRAM;
411
. - CHESKWtAIE
HEE�-S CZE750 Mti A
GASUN� 13Y
J _ •� �. h:•7' iem.. ! v-. ' "�' t j. • ~�. .!n', a'�• .'� .. . ne'n'+=w.•.•..c.x:v.o...s. .� + 'PCI`JL L ,, -! oy 3 .
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ELECTRIC 5'
HUCfR'CA•_ BONDMGi BY_
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FIN H
CCNT-4A rTO c mwit r.e
L1A9 /1v L4 WN :# r respurrsdagity for damagexo s
p _ = - �_ �t> � euros, s�ks. cra--Wm
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ri •'G _ _ .. "" +.ti+ - _ '''...- �.�..�.f �r �_ ! - 12rJ1713,ir�':eS #e°��'... Yt°•:3CIve1C
�° w2�s, s I dtlers. t29e ne 6tte5
I or srrubs. When access * made
thr^+,ugtt a neiglb's pmpe+rty 'r. is
undgmtood &ar ym this awww. �
have that neic Mxes pent sinn
� assax se f�.i respansitrailitw. r
tan
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a�7oi"! gas 1.O 21
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Pods
SHOW ROOM
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COUNTRY CLUB OR- SM F -A
+ ��. _ - ,- - _ .� -f t •�� s \ '• i P•411R DESERT. C.4. 911-260