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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
' Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
6561209 053 r'�t 10I3V98
dDate } 11 J 5 b Signature of Contractor t r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'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
Sect ion 3700 of the Labor Code, for the performance of the work for which this
P.
rmit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier -Policy No.
,S'.CATE FbT.ND 046-98-0006163
(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 prow siopof�Section 3700 of the Labor
Code, I;shall-forth ith comply with those provisions.
,/Date: 5 i I r , Applicant
Warning: Failure to secure Workers' Compensation coverageX 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 allCitC'Ity, and State laws relating to the building
construction, and hereby autbonze re entatives of this City to enter upon
tie above-mentioned property for i ection�.urposcs.
Signature (Owner/Agent) Date
PERMIT# CONTROL#,
BUILDING,.*PERMIT 9$03444
/�
DATE VALUATION $]5,09 f�.00 LOT TRACT S 6 22
iz VV L 66..
�/
JOB SITE 11
ADDRESS 860 HE!RN11TAGE
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
KSI. LAND 1.1
CALIFORNIA POOLS & SPAS
56-1110 PGA BLVD.
14-725 JONI DRIVE, #A.
LA QUINTt1 CA 92253
PALM DESERT CA 92260
(760)340-90110 CBL# 355
USE OF PERMIT
POOL
cPOWSPA A BtQALARI IvMARRIEAS ARE TO T3E OPUIRATIONAJ, 1
PRIOR TO EN -CA INSPECTION PAD
1998
POOL AN1D{OR CPA 15,C100.00 LS At
aTY OF
LA OUNTA
CY11RIATED COST OF CONST�39:lC`.T1OM
i�
A`i i31I11wti ?
4 _
PE�iAW FEE SUMMARY
PLAN CHECK.Fn 101-000-4.19-31.8 $145.30
CONSTRUC171ON F& 101••000-418-000 $162.04
MEC"F.IANICAL, FiXZ -- POOL 101-000-421-0160 524,4t)
1 LEC'1' ICAL:i H -- POOL 101-000-420.000 $45,0)
PLUMING FIX, -« POOL 101-000-419-000 �27:tsr1
SUB-fra1AL CONSTRUCTION AND PLAN CHECK
$30.1.30
LL Si 1'11♦-PA.j1D I.1s kS
40.00
TOM, PERMIT FEES DUE NOW
$363.30
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
3�
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
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:
� t o -508-3..— /"S7,#VP,;2 4 ll re Zy
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
c'
t
Final
Li ility Notice (Perm)