9510-102 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 47 07 C: 121303
License # L�. 6aass > n . Dave10
,Data 10 — L1.14, Signatureof Contractor_ /'fir ..c G -c. ,r -
OWNER -BUILDER DECLARATION
1 hereby affirm 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 seN-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 s `I•!� f ii3+�r' Policy No. 47'i*fl5
(This section need not be completed if the permit valuetionis 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 1 should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shell 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 $100,000, In
addition to the cost of compensation, damages as provided for InSectlon 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby. made to the Director of Building and Safety
fora 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'
work is not commenced within 180 days from Adie of Issuance of s
permit, or cessation of work for 180 days will subject permit to cancelkw
1 certify that I have read this application and state that the above information _
correct. 1 agree to comply with all City, and State laws relating to the builds,
construction, and hereby authorize representatives of this City to enter upon
above-mentioned property for Igsp6ction purposes.
S�Ignature (Owner/Age • .��T..4? t% ��,.C.�a.. Dab
A`°'
BUILDING PERMIT
PERAAITy��D-ltl7
DATE
VALUATION $14,000.01(.11
LOT TRACT
JOB SITE'ADDRESS
78-740 W. HA€iLAND _
APN
6100231-001
OWNER
CONTRACTOR
A-Q0A.QI)f,5 i' POOLS
HUG -111 R & JOAN BARNf7r1'
80-97511 DIO !BIND,
73 740 HARL.AND DA
PALM DESERT CA 92255
L.A QUINI'A CA 92253
(6191345-5070 Cf11,1; 130
DESIONEWENOINEER
(
USE OFPERwPoo ., A -14D DOR SOPA
FEE DESCRIPTION
FEES
POOL A14WO7 SPA i4,OQ0.GG LS
F-ST1NTALTED COST OF CONSTQRUCUON
14,0011,00
PLAN CHECK FES 101-000-439-318 $99.45
CONISTRtX" i9ON FEE 101-000-418-000 $153.00
MFCIL414ICA►L FEE -- P(K)L 101-(#W-421-000 $1414.00
ELEC l'RiCAL.:FEE --,P00L 101.000-42.0-000 115.00
P'LfJ?1 ING FEE -- POOL 101-000-419-0110 527.80
SUIS -TOTAL C'ONSTRUC11IDN AND PLAN CHECK
$348.15
LESS PRE -PAID FGIS
$0.00
OC�3 O TO'"I'AL P!~;Q MIT FURS DlIj NOW
1 ,995
$3x88.44
C L �' LIES
TOTAL PR0JF r P �;RNIO i� � ' '
348.45
RECBPT
DATE
BY
DATE RNALED
INSPECTOR
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
Paity Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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 W17 bef &W
Gas Piping
Gas Test
Appliances
Final I'l 31 Tr
Finale
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Win Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
AQUAOUEST POOLS
: VM BOX 11266
P&M D@Wk CA 02255-12DS
, cg ED I
7013E 1
EjcLOSED E y
p 0 L E.
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W. CL04�1.
AL
LL GATES
OF LA QUINTA
ING SAFETY DERARTMEW
C-01DITICHALLY
;..CT TC) IMSTALL�,.' A,13 P Ejq
AND
L I P OL
ABLE-:
Is
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