0007-233 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
yH Chanter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Pr°3feisionals Code, and my License is in full force and effect.
p M License # �.� Lic. Class Exp. Date
�/ IJb C53 07/3112(
oZ t- Date Signature of Contractors r
CDO_ri i
It- I.— C:) OWNER -BUILDER DECLARATION
dW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z ( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
O N
O)
dQ WORKER'S COMPENSATION DECLARATION
C:, 2 Z I hereby affirm under penalty of perjury one of the following declarations:
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
C0 Q U) I have and will maintain workers' compensation insurance, as required by
O Q Section 3700 of the Labor Code, for the performance of the work for which this
IlH permit is issued. My workers' compensation insurance carrier & policy no. are:
ob z Carrier FRM0WT,I!li PLOYE Policy No. wc.w 3012094
�C)
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(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 Ca iforjnia, �jd agree that if I should become
3 subject to.the workers' compensation provisions of Section 3700 of the Labor
Code; -1, stall fo ith comply with thos pro slons�
Date: I / � 7 t Applicant 1 4
Warning: Failure to secure Worke s) Corr)pensation 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) i � r � Date, 7b 7r
g
/ ,BUILDING PERMIT PERMIT I/
r7
DATE `/7J� VALUATION LOT`• TRACT
JOB SITE r
ADDRESSIDEAC:01q,D1Z V.E`..AST
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
art 9iTtlidC�EbL
RO-BIMI' AWSWOWM POOL CON911WETCTIC
78.511 DEACON DRIVE LLA f
74852 L N- NON PT„AC.E 43
LAQTTITA CA 92253 t
;PALM :t?li= CA 92211
C`160)568.4993 CY114 5115
USE OF PERMIT
P1001, AND/OR 'PA .
POOL & NPA ONLY•A2.,A1tM-SIBARRI • ft Y SHALL BE IN PLACE J,T ;'EKE
PLASM DISPEC t'ION.POOL RQUJ PM WT IsNc`LOSURr IS NOT fNI1'tiD9D /
IN THIS PERMIT
POOL ND/011 SPA 4000M LZ
ESITKNI113) COWr OF CONT1?WMION
245.000M
FERAff rr EF SUMMARY
PIAN C1.1ECK FEE 101-000-39-318 $163.80
CONSTRUCTION ELSE 101_00"19_000
MICHNNIC L FE E -- FOOL 101-000,421,000 E24�0(►
ELL+C,Tft3CA11., VF%— POOL.. 101-000.420--000 °xSd�.QQ
PUgI.ABING F.GE •POOL 10`1 1300.41 J -C100 327,00
JUL 2 8 2000
-ILA Q111
F
'
903-S-TO'PA'i C:ONIETMtiMI ON A-)1 I? ALAN CHECK t ;
$511.80
9 izss PRIK-PADS FFi0
$0.00
TOTAL T Mf4 DUE NOW
i X30
RECEIPT
DATEBAY
DATE F NAILEDe`
INSPECTO
M
OPERATION DATE INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Root 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
_
S
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
4
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping .
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
w
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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10 CLU ULUrL
ARCH[Tz—CTURAL D&SIGK REVIEW
Jti y-26, 2000
I& Greg Butler
Building and Safety
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re: Stringer, Jr. Residence
Lot 1, Phase 28g7n-`2, 78-511 Deacon Drift East
SW&=1r;g Pool Review
Dear Greg,
Via Fac m*
760-777-70J I
This letter v& serve as ADRC approval for the above referenced swimming pool Coc-py
attached). If you have any questions, please do not hesitate 114 call.
Thank you.
Sincerely,
i
Christina I Doles �/ L
Architectural Review Coordinator
/cjd
Joel Geeson, Ainsworth (Vd fzmt rlass mail)
Gary Lohman, General Contractor (wa frsr class mad)
Krish Hanson, Architect t &tint class nwgJ
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