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LICENSED CONTRACTOR DECLARATION
I,h rreby 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]
483798 1 C:F�WUt��t� & . Sal199
,
rDate 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.G. for 4ALthisr assoon�
Date fl201j,"< ,"C Signature of Owner ^4 - � t
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.
STATEFi r�tD 1�23$4�Q
(This section need not a completed if the permit valuation is or 00.00 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 provisions of Section 3700 of the Lapor
Oode� hall orthwith complyith those prov�S ons
VDate:.5 �1) )( Applican"ItILl�.0 Mp P - ?JI AVWtllk. &-W
t
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
thVabove-mentioned property for inspectio tpurpos
V +vu cQ Eve
V gnature (Owner/Agent) ;� A 1 -; � �.•_� a � Date <1 2%a
kK
BUILDINGPERMIT PERMIT# CONTROL#
DATE VALUATION LOT 9805-084 TRACT.
7117 1j J. 1 7
JOB SITE r
APN
ADDRESS
44-:320 AVMI DA HERRCRA
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PAULA DEAL
PURRFECT POOLS AND CON5TWIC110N
54-32.0 AVlrNmA HERRERA
P.O. BOX 1524
LA QU3NTA CA 922.53
PALM DESERT CA 92261
(760)w-i9b3. c1.13L# i)5
USE OF PERMIT
_t
..
1P
POOL AND .VA.ONLY
1/ I7 7 V Y c V d Y Y
= MAY 2.•01998
POOL ANDIOR SPA 1t,50o.0o Is
K
EST11MA'T.ED COST OF C'ONS'I'itl.fCTI ON 11,Si)1s.1i1!
PERIWIT FEE SUMMARY `
PLAN CHECK. FEL 101-000-4:39-318 $87.75
CCONSTRIX ION FEE 101-000-418-000 $135.00
MECHANICAL F!:1 -- POOL 101400-421-000 $24.00
OXOTRIC:AL FLS --.POOL 101-000-420-000 $45.00
PLtAfflING FEE — POOL t01-000-419-000 $27.00
SM -TOT -AL CONSTRUC71014 El.ND PLAN CHECK $318.75
LESS PRE -PAID 1 EE.S
TOTAL PERMIT FEES DUE NOW $318.74
RECEIPT
DATE
BYE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
v
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
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
Sewer Connection
Gas Piping
Pool Cover
Encapsulation
e�9�
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
Final
tility Notice (Perm)
COMMENTS:
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T&EC D OSNFAODR, RIIR T
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SUBE%,
TO JNST;Y,f
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AND ALL APF-)?
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