9704-033 (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
NNessionals Code, and my License is in full force and effect.
•License# Lic. Class,' Exp. Date
39- W2
*<7 �� �>
AN' � Signature of Contr cwr.-�
f
OWNER-BUIL'rDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Gofitractor's
License Law for the following reason:
( ) 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 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 agife that if I should become
subject to the workers' compensation p�ov sior�I 'f Section 3700 bf.the Labor
Code, I shall f_orthwit� comply with those p�ovi I s
Date: ^ 1 .� Applicant . F'� hf
�" yy++
Warning: Failure to secu��W rkers' Compensation coveyiage�is lawfu'I'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. " �r
r
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. R
1. Each person upon whose behalf this application is made & each person M
whose request and for whose benefit work is performed under or pursuant to e,
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
correct. I agree to comply H
construction, and hereby at
21griature
eabove-mentioned proper (Owner/Agents,[
n and state that the above information is
y, and State laws relating to the building
pres4ntatives of this City to enter upon
e do � purposes. a
Kw
Date
- - -4!1�' - — - f— - -
BUILDING PERMIT PERMIT# CONTROL#
`>704-133 4938
DATE a/ 41+17 VALUATION8t'�,liti,(►�s LOT TRACT
JOB SITE
ADDRESS 44-770 �r��'I�IV �ERltt\
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
I:1(lK W AtITCH,
;; DIA1tt Pool's
44-7 770 F.RUN'MKRA
0. boX 935
LA QUIMA" CA 922.53
PALM I.XiSERT CA 92761
CBL# s �
USE OF PERMIT
11CKJL
POOP. AND 4%, li . iJ'NLY
V't MIA'1'ION 14,000.00 Ls
i+'+4';1:fjVIM VID C(S'1'O1+ CQNS'A'IEiUCfIGN
14.000.04)
SUhIMARV
PLAN CKC X, �"Ea.la S99.4:+
COMMUMONOTT (ID.1-Aa i'-=l;l t f 4i'4100
ii�YfXHANICAL ME— POOL lot -000-421-000 $24.00
�Jd«'�.w; �(�\..•f`e.ti },'1,L}'S '•^.��./t�'.}.r "" .��d d. ^�it/.V`WL�I°'iilT�l �i �.t,�t�
PLttA9 �f�f4> :M t: - t ltjf: 101x000_419 -U()() $2'I.tfr► .
PAI t'r `I AI. C.C)N 11AUG.n. )N AND Pt.AN CHECK
$3,18.45{
USS Prat; -.MUD P:c:r:S
$01A)
APR 0 81997
i(l_TAI..rIERA111' F>EE$ DUE, NOW
CITY OFLA: C INTA .
RECEIPT
DATE ¢
BY / /
DATE FINALED
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond 717 777 1 L7r
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Locadion
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
AA
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
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
153196
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CITY OF LA QUIN 11
SAFETY DEPART
BUILDING&
CONDMONALLY
ACCEPTED ED rO'.)NSrcf 1(� i..` ''
PLOT PLAN
.ra i.r
—f IERAI. SPECIFICATIONS
S x3 Code Q
3 to to to -�
w34- 1 e0
Coping 12' Cantllever E
Pool Capacity Z/ O O 4=1 Gala.
nrnr br - G ,, S Hrs.
Vacuum Line A Skimmer
Return Une 2 — ! •
Main Drain •
SkimmerlA-L3 L.'" /, •
Backwash to
Healer l/K->q-✓t ,� sine 2-'s—o'Do &T.U.
Gasline byS ///yA- AE�ft by.5 (/R�/¢►'.,%2
ught /— Vo O 1. -/ v a
Time Clock
Decking A S
Board :;i� Cokx �--
I Slide . _. cam G8-"
f v t 3 -7 t^ y
AL
3_ 2�r-� h
NO) D 12-1 ,�kA.`.
OEE/
ENO 6 3
1 SHHANLLOW
SCALE 1/t" • 110"
Name /C / cl/2- 1IS/9 -^e wf t (.'tGt1
Address y 7 7
city L>4 L./l �-
Cross Streets eAP-d-4n--
Plum
Dela L/ 3- 17 Drown by: AA. -t-
SUNAIR
\ -D
POOLS
0
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SINCE IM
pa lit No
P" OMWIT. rA ti22et