9512-070 (RPL)LICENSED CONTRACTOR DECLARATION
~ I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
WSection 7000) of Division 3 of the Business and Professionals Code, and my
O Lo license is in full force and effect. 69077$ C33
n WW Licenser# , _ Lic. Class Exp. Date
Z Date t / r i,SignatureofContractor-f--
/`
CDD p OWNER-BUILDER DECLARATIQy
J IU 1 hereby affirm that I am exempt from the Contractor's License Law for the
1.1
CL following reason:
Z ( ) 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
M Date Signature of Owner
LO
N
O CNJ
rn WORKER'S COMPENSATION DECLARATION
aQ I hereby affirm under penalty of perjury one of the following declarations:
C)
-g Z ( ) I have and will maintain a certificate of consent to self-insure for workers'
u-)i 9 0 compensation, as provided for by Section 3700 of the Labor Code, for the
X W W performance of the work for which this permit is issued.
p J J ()<) I have and will maintain workers' compensation insurance, as required by
m Q U Section 3700 of the Labor Code, for the performance of the work for which this
O U permit is issued. My workers' compensation insurance carrier & policy no. are:
tlU I<
Carrier 'i i= Policy No.
Z (This section need not be completed if the permit valuation is for $100.00 or less).
r- 0() 1 certify that in the performance of the work for which this permit is issued,
Q 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 provisions.
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $1.00,000, 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 application agrees to, & shall, indemnify .
& hold harmless the City of Indian Wells, 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.
Signature (Owner/Agent)
ALC '
BUILDING PERMIT
PERMIT9512_074)
DATE
VALUATION �>ca,�rW.i>xi
LOT
TRACT
JOB SITE ADDRESSAPN
50-525GRAN 1) TRAVERSE
OWNER
CONTRACTOR
DKI76 PALM ENIERPRISES
.AYERS CROUP
78-070 AVE, PRIM'iAVERA
355 BRISTOL S1. #.A
CA:rHEDRAL CI'T'Y CA 92234
COSTA MESA CA 92626
(619)325-21237 CALIF
t714j54O.W60
DESIGNERIENGINEER
USE OF PERMIPWL AND/OR SPA
POO), AND SPA
FEE DESCRIPTION
FEES
POGr AMIOR SPA l�l,l)lJ0.t111 a.,S
E5'TPllMATED COST OF CONSTl+UCCION
14.000.00
PER15 ITF11ESUMMARY
PLAN C .F.CK F E6 101-000-439-318 $99.45
CONSTRUCT ION FM 101-000-4113.000 $113.00
MECHANICAL.FEE --POOL 101-000.42.1-000 $24.00
67,Ef7MICAL J'"r'gE -- POOL 101-OUO-420-000 $45.00
PILLT D NO FEE -- PIOO . 101 -OW -419-0130 $27.00
SUB -TOTAL C..fJPdMUCTION AND .PLAIN CHECK
$343.45
LESS PRE: -PAID FEES
$0.00
1 `I01.4L PERMIT FE S DUE NOW
$338.45
13 1995
RECEIPT \
DATE
BY
DATE FINALED
INSPECTOR
o
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR `
BUILDING APPROVALS
MECHANICALAPPROVALS
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
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
2-1 ��✓
Underground Plbg. Test
Final
Gas Piping/-
PLUMBING APPROVALS
Gas Test
Electric Final
Z
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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:
_ CITY OF L.A QUINTA
6UILDING & SAFETY DEPARTMENT
777.701.'
INSPECTION REQUES f LINE
777-7153
FAIRWAYS LA QUINTA
or AYERS GROUP --_--_— __
umber _9510-070
)ST ON JOB IN CONSPICUOUS PLACE
_CTOR MUST ;SIGN ALL APPLit:;ACLE SPACE
DRESS 50-525 GRAND TRAVERSE
,OT 17 PLAN 3
(PE OF INSPECTION
DATE
IN3P.
--
TION & SETBACK
~_
3 STEEL-
_....-----
— --- ---
'OUND SYSTEM
EAM
PLUMBING
N
NITE
F
_ ___
POUR CONCRETE UNTIL
ALL-80VE HAS BEEtSIGNED
I E SLAB''��,�y^,�
GIRDERS
FINALS
CAL GROUND WORK
AL
(POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
LECTRIC
;AS 8 GAS TEST
& VENT A/C
'E
_....-----
— --- ---
EAM
_
WRAP
N
z:—
F
VER NO WORK UNTIL ABOVE HAS-BEEN_ Sl(,NED
INTERIOR _—�� ��=6i
I LATH
PLASTER
4CE 8 GATE
'PTIC TANK_—
FINALS
r
AL
a _
;TEST
'LETEDWEIR
BONE
,BONE APPROVALS DO NOT INCLUDE ;4IGHT TO ,
TURN ON UTILITIES OR OCCUPY BUILDING
s