9903-108 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W '"Prol�&onals Code, and my License is in full force and effect.
=) ch License # Lic. Class Exp. Date
a yt3(hs1 X53'%lft)0
_
o Z r— XDate,;71T Signature of Contractor;Q�AA j
(Dpr` �
� OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U 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).
' co () I am exempt under Section
LO B&P.C. for this reason
N Date Signature of Owner
O rn _
a.Q WORKER'S COMPENSATION DECLARATION
> e_ CC, I hereby affirm under penalty of perjury one of the following declarations:
Hp () 1 have and will maintain a certificate of consent to self -insure for workers'
K W �: compensation, as provided for by Section 3700 of the Labor Code, for the
:) J Q performance of the work for which this permit is issued.
n Q I have and will maintain workers' compensation insurance, as required by
0, Q Section 3700 of the Labor Code, for the performance of the work for which this
L'LO Z Z permit is issued. My workers' compensation insurance carrier & policy no. are:
d ` Carrier 'Policy No.
d /t1t V'7 r!Mr /
.l< (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
3 Code, I_ shall forthwith comply with 4 ose'prov'sions. +
Date: = � ; �}� +^� ? Applicant ` + +" I ,3 ",
a1
I I %. r 1 -.., y..
6 Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
111 of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
C*
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
\. any permit issued as a result of this applicaton agrees to, & shall, indemnify
�^Vip & hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prop.erty_f,Or irispection purp/osse's.
Signature (Owner/Aaent) t ' 1 M 1N" Date
BUILDING PERMIT PERMIT�3-108
DATE VALUATION S32.OIS(1 LOT TRACT
JOB SITE
ADDRESS 78-41.11 D e�.� ON DRIVE ,.AST
APN w r
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1:fZI3 I;T Dt1'U!`J
!'(ACX C;CN ISTRGG" T
6457 JAMES ROAD
73-0-',3 fi0MMA.
LA 52722
PALM 1II SEW'i (;A 92260
(760)5(R4993 CA1.0 illi
USE OF PERMIT
POOL AK_D. AA SPA
1100 SPA, ALARMSA3i+,i21`UER i "iI'it4.1.i. BF iN iV PRU-PLASSMR
A Choi. ALYW OR SPA. 32,6M.0f, LS
EST lYI.041) COST (",!FCJVitp$TRVOA i.'iY,{!T
PLAN CHIiCK HE 101-()00-439-318 stt t.3$
d1,0N :1YRf Wmtt.?w vrl, lilt WW -418,01 I i !�►7,4i1
'ti IEC'IIr1XIC,A,11, F,ME.., I`i 01. !011.000-121.0(}0
IIILFKNRIC At. FEE— --.i'CX& 101-•000-420-000 $4 i.00
Pt UMBiN[14'ER— til. 101-000.419-4X)0 $27AK1
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R• 1 0
k
St JI1-1T)TA I, CQ''K.�TAUC-1701N .ANI' PLAN C:)
$tst4i RR
USS *fftU-VA1I7 F1 -:ES
$0,00.
04 A
y 'C()`!.'A1,
P&Mi Iff V.EEN DUE NOW
,r,►-+yi6.8s
MAR ,1 1999
`, r) 1 a t� t .�
RECEIPT -[bAfEf
BV
DA FINALED
INSPECT0
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rr
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 lAd
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 Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
tradition
March 9, 1999
Mr. Gary Lohman
ANDREW PIERCE CORPORATION
Post Office Box 3420
Palm Desert, CA 92260-3420
R'e: Lot 11, Tract 28470-1
Dear Gary,
WA
1 ne ARRC: has approved the 'revised" swimming pool plan you submitted subject to the following
conditions: '
1. Provide samples or specifications of finish materials.
If you have any questions or need additional information, please do not,hesitate to�call.
Thank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd
PC: Robert Ainsworth, Pool Contractor
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78505 OLD AVENUE 52 - LA QUINTA - CA 92253-1120 PHONE 760/564-3355 - FAx,760/564-2356 _.'