0008-312 (RPL)W
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r LICENSED CONTRACTOR DECLARATION
Qhereby affirm under penalty of perjury that I am licensed under provisions of
Chap�ter..9 (commencing with Section 7000) of Division 3 of the Business and
Profe�ionalsXode, and my License is in full force and effect.
. , License # Lic. Class Exp. Date
614611 C5 0 12t
Dat � PSignature of Contractor ''�"�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: 4
( ) 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). - E )
( ) 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 W1LLriAAASDURCi INS. Policy No. WCG11704.01
(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' compe sneion provisions of Section 3700 of the Labor
Code, I alh(p{tl v L�yomply\w'th those provisi ns.
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 represen at vi es of this City to enter upon
the above-mentioned property for inspection Purposes.
Signature (Owner/Agent)
BUILDING PERMIT PERMIT/t
/,� }� 0"-3112
DA`TE�` jam) VALUATION LOT TRACT
e 'tel.! � � ISMOW 00
JOB SITE
ADDRESS fj1,_(Wo 001,1 V.I'CW Dil.1.W
APN
O NER
CONTRACTOR/DESIGNER/EN (NEER ,
t
ROGER SCF1rL.EMGI...R.
M'MTU POOL--, &SPAS
81.040 GOLF VIEW DRIVE
P.O. BOX 1791
I A QUWA CA: 92253
LA QUINTA CA 92253
('760),360-3585 MAN 1945
USE OF PERMIT
FOOL AWVOR 3P A
POOL &:SPA C1RLY-AJ.;At'tMS16Attl:IERS sHA1.,I, BF 1•N PLACE A7 PRE
PLASTER INSPECTIO- POOL EQUIPMENT rKNCL08URF IS 140T INCLUi�i�.13
rN THIS PFRfIT,
POOL ANDIOR SPA iS,09D.RD LS•
1'1'VfWXMD C09r OF CONST RIJC17,,O.P1
M".RZIbiiT M1 .. SUMMARY
PLAN CNPCK FEE 101--000-439-318 $10.3,30
CONSTRUCTION FEE 101-000-419-000 $162.00
M1'.KWICAL, ME -- pool, 101-000-421.000 124,00
ELECTRICAL FEE- POOL 1101-000--120-000 $43.00
PLYriV)bl' O FEF, ...POOL 101.000419.000 $27.00
w
SUB -TOTAL C0Pg1 UCE1OW AND, PLAN 0i .CK
1.0363.30
LF33 PIM -PAID M-9
$0.00
ToM_ YkILNUT13 DUE NC)�N
$��►3C�0
AUG2'2000. t
PECEIP!; I f Y ,U
6
:DATER � eai U JI'M I
r�L
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
-7
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Se Backs
.,Underground Ducts
For,. is & 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
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
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)
Sent By: JM KEEHN, CPA ;
i
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L -
8185015054; Aug -17-00 14:54; Page 1I1
is C-�. }z\,eehn
AN ACCOUNTANCY CORPORATION
18800 vaNTURA BOULEVARD. SUITE Ms
5NERMAN OAKS. CALIFORNIA 91A09
19151 sol -Was
FACSIMILC 19161 501.6094
Mappep!
CALIPORNIA SOCIETY OF
CERTIFIED PUBLIC ACCOUNTANT!
August 17, 2000
the Cil y ol La Quintal Building Department
; a Qu' sU4 ca
To M t May COMM:
am m t r nesting the approval of the Homeowners Assocaatian for the building of my
Pooi a at 81-040 Golf View Drive.
please the necessary perxatits to MY contractor Me Intyre Pools as soon as possible.
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