9606-029 (RPL)U)
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LICENSED CONTRACTOR DECLARATION
I hereby of E':,. under penalty of perjury that I am licensed under provisions of
Chapter 9 t-Ancing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
614611 C53 3!3 7
r
DateSignature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following6reason:
( ) 1, 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 Asmeyd M�r;tvytorkers' compensation insurance 9TKIA . licy no. are:
Carrier Policy No.
(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
Code, I shall forthwith comply with those provi ions. r
Date: i'� Applicant i r' �%
Warning: 'Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civilfines 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 inspectiorf purposes. .
Signature (Owner/Agent) Date �=
PERMITN °°NTR°`"
BUILDING PERMIT
s►r+i-f�z� 346-0.
DATE �faa6 VALUATION LOT � TRACT
JOB SITE
APN
ADDRESS 79485 FOX RUN
OWNERS
CONTRACTOR /DESIGNER ENNGIINEER
_'.& S4AS
MC iN11YR rf1.POO LS
L
g NIOUNfAN SHADOWS
JJD
i .1�ESl
LAQUIh(IA CA. 92153
LA 01J1AJ'1:A. CA 52253
C; lUl 1345
USE OF PERMIT
KYA. %1NDf!-M SPA.
P()OL AM) SPA ONLY
t%i3t)� AN1X0A U*A
ES7'€M WIT, 1) C<+111tiT 0..F CO S'i•.KCC',110N
P>r.RWT 1+'1+.E NlfMlblAlt V
'f,AN a,'.HECK FES:
CONS°f'iLCf#;," [`;<OPT FFY.. 101* '000A18_000
M13. 54 1, ale; t ': s" . POOL 101-000-42.14A
RAX,1110CAL FEE -V001, .1014)0Q-420-000 $45.09)
Pf..ltntcltt4 ' _ _ l�ti at; 101-00,11JI-4,19-Ulf}'
i1.l l: -?''AL CX:1+15"1R)JC::t'IC)Itir.Al`I:1r LANCIIECK
3cF'1.341
- LESS 41.8-8.11 M.F.l~1AS
1 -J U N 07 1996
By _
RECEIPT .
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
"'r -4t Backs
Underground Ducts
xms & Footings
Ducts
31ab 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
Fbdures
Main Service
Sub Panels
Eiderior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
i
a
s CITY OF LA QUINTA
OF BUILDING & SAFETY DEPARTMENT
777-7012
CITY OF IA(RAPECTION REQUEST LINE
777-7153
JUN 07
Owns
KN LLII co
Contractor)POOLS & SPAS
Permit Number 9606-029
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-185 FOX RUN
POOL AND SPA ONLY
TYPE OF INSPECTION
DATE
INSP.
FOUNDATION & SETBACK
ROUGH GAS & GAS TEST
FOOTING STEEL
HEATING & VENT- A/C
�t
MAIN GROUND SYSTEM
ROOF
GROUND PLUMBING
'FZ
As
PRE-GUNITE 14 71.
DO NOT POUR CONCRETE UNTIL ALL AB6VE HAS BEEN SIGNED
CONCRETE SLAB
GROUT ❑ 4' ❑ 8'
'
JOISTS & GIRDERS
INSULATION
ELECTRICAL GROUND WORK
PRE -ROOF
r`
. la
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEF,N SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
1 _
HEATING & VENT- A/C
�t
FIREPLACE
ROOF
BOND BEAM
As
O.K. TO WRAP
+�1
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
� 1 �S � i� 7 s �%r•
COVER NO WORK UNTIL ABOVE HAS BEEN S'GNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/.96 TURN ON UTILITIES OR OCCUPY BUILDING