0011-237 (RPL)LICENSED CONTRACTOR DECLARATION
Cf) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
r- d U.)
r` W 686895 (75.3413(NO2
oZ t- Date / Signature of Contractor
CD o rl�
J U CD OWNER -BUILDER DECLARATION
Hd � 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).
C'') () I am exempt under Section , B&P.C. for this reason
ul
N Date Signature of Owner
0 CV
O)
d Q WORKER'S COMPENSATION DECLARATION
O 2 Z I hereby affirm under penalty of perjury one of the following declarations:
0 () 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.
m Q U ( ) 1 have and will maintain workers' compensation insurance, as required by
O U : Section 3700 of the Labor Code, for the performance of the work for which this
tl 0)Z permit is issued. My workers' compensation insurance carrier & policy no. are:
+ Carrier Policy No.
ob =i STATIC MID 1517a1192•0a
r` 0
Q (This section need not be completed if the permit valuation is for $100.00 or less).
J ( ) 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
1 subject to the workers' compensation provisions of Section 3700 of the Labor
�I Code, I shall forthwith comply with.Apse provisions.
j Date: Applicant—
Warning:
pplicant 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 attornoy'c fooe:
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, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
i 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
i 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 001.1-237 TRACT
11naw $1 S,S41 0)
JOB SITE
APN
ADDRESS 78 -411 DNACON DRIVB. V",'91
- -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
L 0"Y' T1
CAL.LK)RW-K POOLS &. SPAS
78-411 DEACON DRITV'E WWY
74.725 JON) DFJV.L1, *A
LA (41JINTA CA 922S3
PALM DFMRT CA 92260
(760)340 -Mk ('.PL* 3366
USE OF PERMIT
KC OL AITWOR SPAS,
P001J3PA. ALAI NINBARRIF" SHALL BE IN PLACE AT PPX-PLAST1r.R
INSPRCTION, KX)L EQUIPMENT 1SNCL. VUU 18 NOT INCLUDED,
FOOL ANDA R SPA I x„400.00 LS
x91i1119ATIM COOT OF CONSTRUCTI01f
13.S00A0
PkRbSIT FEN NUMMARY
PLAN CHECK YKE 101.000-439.318 $111.15
CONSTRUC1tON M9 101.000-418.000 $171.00
MFCHANICAI.. MY •- >'OCA. 101.000.421-000 924,00
ti
RLLSC'TRICAL. MR1E - POUL 101-000-420-000 $43.00
PL.UMBIN+C' "I -- POOL 1014XV-419.000 $27.00
YUB-TO AL CONV.CP 0C nOW AND PLAN C''HWIX
$378.15
lass PRE -PAID FMW
S0,00
TUTAI, Y'NRMT XIML 3 DUE NOW
$37&15
LRECEI�
DAT
2
BY
DAT D
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
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:
'3� 'Tradifion
ARCHITECTURAL DESIGN REVIEW
1
November 22, 2000
Ms. Nickie Gormley
CITY OF LA QUINTA
78 -495 -Calle Tampico
Via First Class Mail
and facsimile
La Quinta, CA 92253
Re: Lamperti Residence, Lot 6, Tract,28611, 78-411 Deacon Drive West
Swimming Pool Review
Dear Nickie,
a
This letter will serve as ADRC approval for the above referenced swimming pool (copy
attached). A five foot setback must be maintained between hardscape and rear property
line. ;
If you have any questions, please do not hesitate to call.
I ,
Sincerely,
OL --X"
Christina J. Dores
Architectural Review
pc: Mr. Rob Capetz (via first class mail)
Mr. Al Lamperti (via first class mail)
78505 OLD AVENuE 52 --- LA QuirrrA -- CA 92253-1120 --• PHONE 760/564-3355 — FAx 760/564-2356
IDI
II