0201-172 (RPL)LICENSED CONTRACTOR DECLARATION t:t7`
I hereby affirm under penalty of perjury that I am licensed under provisions'
Chapter 9 (commencing with Section 7000) of Division 3 of the Business an.'d
Professionals Code, and my License is in full force and effect.
License # ��r.• Lic. Class Exp .Date
P
z
Date �t� 4 (� Signature of Contractor
�v:�.,j
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).
( ) l; as owner of the property, am exclusively contracting wiih 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 `ate, Policy No. ,,,ur
�,1:1e-ii'l�: l�U ND Ica. Q1.40191K4
(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;,%ncl agreeN`hat If I should become
subject to the workers' compensation provisions of,Se'ct`ion 3700 of the Labor
Code, ;l shall,forthwith comply with those provlsio s {\`
Date: Applicant �" , "N 1
W.�1,
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 Wand 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, indemnity
& 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
the above-mentioned property for inapection'purposes.
Signature (Owner/Agent). Date
1 PERMIT#
BUILDING PERMIT
DATE' • VALUATION LOT - TRACT
i
JOB SITE
APN
ADDRESS 4-,- 3O VIAW1,01RE
OWNER
CONTRACTOR /DESIGNER / EN INEER
f°A,MADAY & COMPANY
HAL 1 3:4°° OR ctbi V.i'+,CAaliMPOOLS
17480 L 17173 Me. #106
5'vd Y`e01M3: X)S,0N' RD.
CA 92,780
1. ERM., VALLEY CA 923S6
Xa
(`160)Z48•6045 C", 4335
USE OF PERMIT
PGOL,i M/0R,'.
i 00,1111.51A..F%t.AXk?MMAPY11EKS :,'.HAJ L BE in PJ. CLI AT ?al'�EWI .FlG:TF:9',.
i1<tikD�ttGslCai�. 3.�C,')t�1,; L�g3bi�R�F`A1'!' �•�tf:L.t3aCit �14�'' fc�C:3di�'aC�l�, ,
VALUATION 151000/00 W,
�;" cm or C4�1'i07C'x'ItiY
K1A.tl2d!
PLAIN C;x'1%.= FEE 101-000-439-31S
COM';'.RUC`1'ION Pi;L 101-006-418-000 �Efi"L.GrJ
bei 114MM3:>; AL YZE —, 3"'001, 1,01-004 x•421-000
U1.1M5'A1`t AL, P'NIA WOOL t ' 101-Qt?�i'�d�'0-�4�
JAN 2 4 2802 1
t
� ..
,
w� or p ¢egg gq�
- 11Avµi>€llwi l.�z�`��1C92IAND
$36+3.30
y7l�ry0l�j�y•j'aggiC��^�i��iJJ�ai�nt,
• � •:.. � �/9�iM1`
'
.. n ipt�•
�W.t1iI
1�,. yf• .C".e�:LS .Q.'!"���%Y:.iN
x {k '
.t�
ry .� bt ttry p NIM pp'��
- `F ?' fAL w'.7Sr.�1dY_ Y��.7s..�ne i 1� 61k; .�i'��'�N
RECEIPT
DATE
BY
DAF AL
INSPECTOR
/
a
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
_ L
Underground Plbg, Test
Final
Gas Piping
_ y
PLUMBING APPROVALS
Gas Test
Electric Final
S-9--
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 Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
L-7
k
r t4
Yj
X�v
k
r t4
t
` ' ••� T AGAI'ION FOOLS'& SPAS
60n Road
Lt_cerne Va11ey,�GA_92356..-, __ -
._�t760)1'248-60.45
•"r ' •' ' _ _� SAX
.(760)•248=2919
.Lic: #C-53-351673' '. •
,.�. - _ = L _ _ .. _ "°-• �r �"�Sales Locations .._ .. _..
BerinUdaunes;"Irvine,: -.-
1,''is City `RialtUa o . .
7 _r ZWriie V611
LO OY
-i--�-- r -
�a_ :-�-=•-.•,..}PST---:`-- ---i--r-----'n. �.. W
J.
SIZE-r'
ER
DEPTH
CH ICE 1 ' S
M� 3
-PDPING -�
P CAP CITY GALS
PUMP CAP TY OPM
MOTOR HP HP.
MOTOR HP HP
FILTER RATE • GPM
• • •F-ATER SIZE' STU
TURNOVER, HRS
SUCTION INES
r URN LINES"
41 ?;� .� ' S I MER MODEL
CHECKYAWE
fr,•
• _ G SLINE BY" FT.
�.' POOL LIGHTGLOCK
+� t ELECTRICAL BY FT
�i .% • +! r
AUTO CLEANER
Ash I! CHEM. FEEDER `
r • PLASTER COLOR
DECK BY SCI.
DECK -TYPE
STEP PA 9FIECS:
f.• A SIZE 7 'X 7 "RAISED
LITE WATTS
+ DUAL LEVEL SEATS
s
DAMWALL
s, DAMWALL TOP
SPILLWAY SIZE ' X WIDE
CAM SPILLWAY
�-'I
M assume responsibility fvr #JETS t }
71A. 64y6SOde"Iks, driveways; -cement
�r;.iti ewrta s trees fences retaining walls,
_sprink ers a¢ne inescirshrubs, ame:
ena s i e' through a neighbor's property ,
it is understood that you, the owner, have that ddr ss' 87660 i%� 10�� jV
_ ----- rieI hbbT's�`ermi W6n and assume full responsibility. II
' . ' � . -•—'--�•- � - - CSC; I� Q Qtit i AJy�a . - - • .
4-1
DATE TRACT L l-.: a , _ LST# fro
SIGNATURE % L