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9810-045 (RPL)_ I LICENSED CONTRACTOR DECLARATION co Thereby affirm under penalty of perjury that I am licensed under provisions of F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. C License # ' Lic. Class Exp. Date - � M �,C'1'Lo ti3UL St) k.;:0 a aiy �. ..:w r t` oZ v/ater' ' —I"- r Signature of Contractor O� r- F- C:) OWNER -BUILDER DECLARATION- LI W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ a 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). ( ) 1, as owner of the property, am exclusively contracting with licensed T contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner O0 Z WORKER'S COMPENSATION DECLARATION o Z I hereby affirm under penalty of perjury one of the following declarations: Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers' i X w �= compensation, as provided for by Section 3700 of the Labor Code, for the O � Q performance of the work for which this permit is issued. m Q C.) (,) I have and will maintain workers' compensation insurance, as required by U O Q Section 3700 of the Labor Code, for the performance of the work for which this d 0 H permit is issued. My workers' compensation insurance carrier & policy no. are: Z Carrier Policy No. cb Z S'I'A1'L 7E, L i s C'.'zi?-J 1 Q (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. I% Date: - Applicant/ ! Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the Above-mentioned property for inspection purposes. VSignature (Owner/Agent) Date CONTROpLN PERMITm0-04 z BUILDING PERMIT , p� DATE 1i VALUATION ,$'34.900.00 LOT TRACT' 8380 JOB SITE79-950 litt0.iAX Y �.fR i, � APN , - ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER r'dYl'T_YA.Oh OC'C'fllf7hfr'ti VtrkIOIVEll '01_l r C 78-950 GALAXY WAY 44-028 El,i kt01FUN Tk. LA i. UIN'rA Cil 9 253 PALM RESEW CA 92260 (760)311f��S5 f. i:T�t.M16.0 t USE OF PERMIT POOL A UO.R SPA 11,00 JSTIA, Ai.AC2i+w{S/Milt{:I RS MALL BE IN AT PR&Pi.,ASTU(2 OC 19 1998 POOL AT -H OR SPA ,000,00 LS -6TY OF: Lai QUINTA � Q NKKI,NVAa's'ID COST OF $.",ONS i a 9.'# R8,Vd1a vfi'`��iu10hmARN, !ALAN t1'4fkC'K FEE {01-Ot►fl-439-31€{ �00 • Ct+`}tJ�`t"Rl;ie'Pi(1N'F'�€F? �Q1-�O(,kgtR_f)(�!) �1(�,�.ti IvT1,C112diCt.%�ar-`:�'��OL t0l^0tt�••g2Ty�Ot' e'21.00 11LEI 'f'ltf AL li- . 'P X51. I,01 -00-d120-000 fin.{1L l�.t.Ult�frl{hlc3.3�1.h -- �.,1-T. i0i-Gf3�-alb-Qi70 Ste.©t� Kt n3-'I'OTA.#. COMS RIK- r ON AND PLAN Ci3T(X $30 30 LESS .e°4i3w-s'AC��•ir l �e3 _ $0.00 RECEIPT .. DATE BY' DATE FINALED INSPECTOR 9 $t It li INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans 0. 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 Steel POOLS - SPAS Set Backs Footings Electric Bond Main Drain _ %— Bond Beam Approval to Cover Equipment L.Qgation Unde and Electric Underg i est /O - 7— 4 3 Final Gas P' ' PLUMBING APPROVALS as Test sand inal _ 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 f 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 t t Final Utility Notice (Perm) COMMENTS: r .- CITY OF LA ()U i \i"T BUILDING &: SAIFETY DEPARTMENT CONDITIONALLY ACCEPTED FOR CONS"9'RU` Tl0N SUBJECT TO INSTALLATION AS PER ' PO POW © AND ALL APPL{SAB` CODES . E i TING RESIDENCE/ / DEP to('glc�8 . COv BY Tat_ P.@.V 1,4Pont LD LD r ami LD LD IL cn a, . co L m m s....:.......... POOL i t I e S FLTE FLTE TUiN VAC/ RETU �f ` MAIN ` tt POOL EOLPP£NT FEAT MASO RY WALL GASL _ LIGHI �10� ❑ B SCI 11,16 5'mlaf-- POOL CFLC. °T P/L LARD SLCIE GARAGE ROPE NlRAI '�QICATION3 V= M -1A BLOCK WALL FRONT COURTYARD ACCESS TRACTOR H" GRADl�G NOME ' STUB PLLNB NO DEC NG 9UNZR9E SO. FT 525/000 CONCRE fE REMOVAL BY:. NODE . RAISED BEAM'•LEK>N WA HEIGHT SCALE I'='8• DRAWNG r- ' THE607HARD FAMLY MOW GALAXY GA QUINTA,'GA ( SUNRISE POOLS PALM DESERT;. -CA. C.jLFOtWwn UCENSE M. C53-556230 . .. _ '-APPROVED BT ---- . _ . CRAWM;F; THE PROPERTY OPU�I Slk POOLS. RE+TAODUCTRN4 OR LNAUTHORZED USE YMMT WrJEN . . : P94`15$M G PROH6ITED. .