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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 A Exp. Date
801877 C:53 Zit% , V31 /0.
Dat9e t3 L Signature of Contr�or 1
i -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury thaH.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
perrpit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier EXEMPT Policy No.
(Tis section need not be completed if the permit valuation is for $100.00 or less).
>J 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 pr`.ovisions of Section 3700 of the Labor
Code hsh I forthwith comply with•th' 'os' ovi io, s
'Date:``? ApplicAnt,------
Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal pe°alties and civil fines up to $100,000, in
addition to the cost of compensatloh-damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. i.
7
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 represdntatives of this City to enter upon;:
the above-mentioned property for �inspectionpurposes.' °
S gnature (Owner/Agent r / Date
BUILDING PERMIT PERMIT
30311.01.
DATE 1114 J VALUATION s��' LOT TRACT
JOB SITE 7 992 FRERA DRM-
ADDRESS
APN
—
OWNER t
CONTRACTOR /DESIGNER [EN (NEER
KATHYDOOL
DIAMOND POOLS MITI) OPAS
79 492' ug -4 mr av-T?.
77-700BNr-=1AM3UTMR
T. QUWT'A . CA 92,253
PALM CA 92211
(160)200-5888 MLO 3155
USE OF PERMIT
POOL AAIIJ/CJI: VA
utay fi,u V& 1753
ALA.t"2MMA18 UMS SHAU.. WK 041'1 AC!.e AT PRJ9-F11,AZ TKR. INSPECTION,
EQUIP1V3VNT Ei3CWSl3P..E'tdOT INCLUDED
POOL ANDIOR :IPS 4: 040. Qtil .I�
4.0W.0V
P`I&I C1'•xIICK FERE 101-000.439.318 $248,30
fi)tdSTRUC: IOW FEE .161.-000-4113-000
MECHANICAL FRE —POW., 101..000-421.ODO $24,00
LL WTRIr_AL VIKE — POOL 1.111-000-420-000 $45.60
PLIaM.I31N0 P4?9 -- POOL 101-- 000.419.000 $27.00
A '
SUB-'i,<5TAT, CC<1tf9'3.7tt, CT'1C7N AND kA t113E4s2,
11'726.30
IM, PRE -PAID FEMS
o if TAPE P RMS' lf=lq TWEI 1�1'��11'
MAR 17.2003' sur
CITY OF LA QUINT
FINANCE DEPT.
RECEIPT
DE, J
BY,��t�
DATE FINA' /D� .
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
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 �-
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring.:_'
Low Voltage Wiring
Fixtures
Main Sg vice
Sub Panels
Exterior Receptacles
G.F.I.
Smoke detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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FROM :J GRAHAM FAX NO. :7603217646 Mar. 07 2003 06:10PM P1
PLOWSW SPA AT *24" VMTH GONG.
GAP. STONL PAGe AND STACK= STONE
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