0007-232 (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
Pro sionals Code, and my License is in full force and effect.
License # Lic.'Class �^ Exp. Date
5986€31 X53 � � ��'I // 07/3112(
Date Signature of Contractor \-...._..,AI/ —
OWNER -BUILDER
I hereby affirm under penalty of perjury that I air/exempt from the Contractor's
License Law for the following reason: VV
( ) 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 1,REMONT Eti3vYpI,oyp Policy No. CCN 30120 -�"
(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' compe sat on provisions of Section 3700 of the Labor
Code, I shat forth ith comply with thosepr visions.
Date: h^ ONpplicant ► ��
Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal enalties 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 foinspection purposes.
Signature (Owner/Agent) l q l Date7�U o
BUILDING PERMIT PERMIT Jt
VALUATION LOT- 7-232 TRACT
DATE 614
52510 AXII
/
JOB SITE /V v
APN
ADDRESS 78 .m Dr
acoyfD nri.A r
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Ofiaz ° LOTIZv M
RO}3.OU AINSWOM POOL C014MTtU'CMCl
78551 DEACON•I)MVEMST
'7485212NNONPIACI #3
LA C3UDTrA CA 97.253
PALM 17ESM CA 92211
(760,)568.4993 MA 5115
USE OF PERMIT
FOOL ANWOR sPA.
POOL & SPA O'hill-Y-AI.,ARNISfl3'.AiikRMA' S SHALL TJM IN PLACE A'!' PRE
PLASTER DISPECT IOUPOOL RQUIPME. T EXCIA)SURE 19 NCS x I"riWIMM.)
tN THIS 'PERMIT
POOL AND/OR JPA 2A000,00 Lt3
:9917ftt7ATED COST 010 CQ11Sr1'1 UC`€ ,0X
�,Ct�U,tltf�
MRAW, Tom: filww"Y '
PLAN CHECK ME, 101.0004439.318 $163,80
CONSTRUCTION PEE 101-000.418.000 $152.00
MECi- WHICAb FEE -- POOL, 141-000-47I.000 $24,00
8L9CCTRICA1. FEE •a POOL. 101-000-420-000 � . 'S43.00
PLUMtINO KE — POOL 101-000.4`k 9.000 ' $27,00
EL
JUL 2.8 2000
9UP-TOW, 001491- UCYAt"aN AIM PLAN CITF'C K. ;
$511.80
LESS PRB-PIa,Y ES
$0, 00
NTAL 12.y'r 1+.&LwL i'.e' ES DlJ.lre.LY'l: 9Y
M
RECEIPT
DATE
BY ,, w
DATE FINALED
INSPECTOR -
N
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
Footings
Electric Bond
Main Drain
O
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
_
�1
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
Vl/
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)
Ar,CH(TECTURA!. DFSfC-M REVIEW
July 26, 2000 Vic Faabnie
76Q777 -70I1
W. Greg Butler
Building and Safety
Cn Y OF LA QUMTA
78-445 Calle Tampico
La Quinua CA 92253
Re: Lohman Residence
to t 5, Phase 28470-I, 78-551 Deacon Drn'e East
Swkmydng AooI Review
Dear Greg,
This letter will serve as ADRC approval for the above referenced swimming pool (COPY
attached). If ym have any (Neons, please do not hesitate tO cadl.
Thank you.
Sincerely,
Christina J. Dores U '
Arjikeewral Re%Jev% Coordinator
cjd
Joel Geesor(, Ainsvrordz Na fist class mai!)
Gary Lohman, General Contractor {via first dans m4fV
Krish Hanson, Architect (na ftn r doss -IMI)
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