9802-141 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l 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.
LiL'ense It Lic. Class `' Exp' DiIte
6 C53 ,� 10131198
VDate ` ` Signature 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:
( ) 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.
VATH F[1lvD (A& 8 -00M 168
(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
wol ers' compensation laws of California, and agree that if I should become
subject to the workers' compensation,.pr iSi ns of Section 3700 of the Labor
Geode, L,shall forthwith comply with those prio�sions.
Vbate: `5 1-' i� Applicant
Warning: Failure to secure Workers' Compensation covedage 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 autho i e. epresentatives of this City to enter upon
tt e above-mentioned property'fo I section purposes. o
vSignature (Owner/Agent) Date 3. 2, �a
BUILDINGPERMIT PERMIT# °°NTR°`
DATE VALUATION LOT 9302-141 TRACT
6599
w 59
.V
$ 14.0#T0.#30 ! - VV VV
JOB SITE APN
ADDRESS
80476 ffERMITAGE r
OWNER CONTRACTOR/DESIGNER/ENGINEER
KSL LAND II CALIFORNIA POOLS & SPAS
Sf-140 PGA BLVD. "4-725 J'ONI DRIVE, #A
LA QUINTA CA 922.53 PALM DESERT CA 92,260
(760)340-M C8L#. 355
USE OF PERMIT
(-1
POIDUSPA WA.TER*F&ATI 2E ON11Y. POPL ALARR+YBARRIlR Rla li,IRE.D
FOR'ENCA.P/PRE-PLASTER INSPECTICIN, (1VJC. »U M 5
}
POOL ANDIOR SPA. 15;000.00 LS
IE..STIMNfED CST OF CONST141JC` 101
15 0#ttl.tf#1
PERMIT FEE SiT19'IMAR
PLAN CHECK FEF.
101.0M439-318
$105.30
CON&FRUCTIONFEE
101-000-618-000
$162.00
MECHAMC L FE -- POOL
101-000-421-000
541.00
, 4
EL.EMICAL FE.E —.POOL
101-000-420-000
$45.00
PLUf4B1NCi FEE -- POOL
101-0013419-(00"
$27.00
c
MAR 2 1c. 99
t
SU13:1'afAL CONSTUI,C`{YON AIR 1 ', 1 1 r.'RAl NT)k y .30
UES5 Pitt':-PAI0 *P'.BJ39 .{Fa
TOTAL PL,3 NMIT N"Elft DUE NOW S.116I.30
RECEIPT I DATE I BY I DATE FINALED I 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 ,. R
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)