9805-021 (RPL)r
LICENSED CONTRACTOR DECLARATION.
I hereby a.nrm 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
j
65612€i C53 l 0031098
Date+' 4y� i 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 i3&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.
STN T - FUND 046-98-0006168
(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' compensationf ro s`ions of Sec' �00 of the Labor
Code, I shall forthwith comply with those -provisions
Date<` ` .:. 1.. J �A Applicant 71r
v
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 Cityf and State laws relating to the building
construction, and hereby authorize/joresentatives of this City to enter upon
the above-mentioned property fore inspection purposes.
Signature (Owner/Agent) .�'//f
Date,
BUILDING PERMIT : PERMIT#
DATE- VALUATION
JOB SITE
ADDRESS
78-945 VIA CARMEL,
OWNER
LOT 9503 -€it] TRACT
7626
APN
CONTRACTOR/DESIGNER/ENGINEER
T.D DES.IrRT.DEVELOPI +IEN CALIFORNIA POOLS & SPAS
79-295 RANCHO LA QLWA ISR 74-725 JONI'DRIVE; #A.
LA QUINTA CA 92253 PALM DESERT CA 92260
(760)-110-9000. CRL3# 355.
USE OF PF,RMIT
MAY 0 5 1998
POOL A1NISfOK SIVA 14,$00.00 r.,S� OF L�� O�INT"A
I
'ESTIMATED COST OF CONS'i'kal3G"11ON 14,1 3It
PERMIT FEE SUMMARY
PLAN CHECK 1`EG 101-000-139-319 $105,30
CONSTRIX11 014 FFA 101.000-418-000 $162.00
f1;C�1AXICA L F1:E -� NC�tJL 101-0004" 1-000 3?A,Ot)
'Et,EC`11UCAL Ff+-E -- KXX 101-000=420-(D00 $45.09
PLUMBING FEE POOL 101-0001.419-000 $27.00
RECEIPT
SUB -TU AL CONSTRUCTION AND YL. -AN CHECK $363.30
.GESS PRE-PAtD.!'EES $0.00
TOTEIL #'.ERAM FEES.DUE NCD ' $363.30
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
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
Pool Cover
Sewer Connection
Encapsulation
Z
Gas Piping
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
Utility Notice (Perm)
COMMENTS: