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0004-182 (RPL)'LFCENSED CONTRACTOR DECLARATION 'T I hereby affirm under penalty of perjury that I am licensed Under provisions of (corriiiencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect.`" License # 1� Lic. Class Exp. Date Signature of'Cor V, li�actor' 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). 1, as 6Wh6( of thf? property, am exclusively coniraciing with ficensed contractors to construct the project (Sec. -7044, Business & Professionals Code). I am exempt under Section 6&P.C. for this reason Dat6 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 pert g.!mance 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 perf6rniance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy No. STATE MD (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, becorrid subject to the workers' compensation provisions of Section 3700 of the Labor Code,'- I shall forthwith comply with thos6 provisionsl. Date: .1- ti't"'O 0 Applicant' Warning: Failure to secure Workers' Compensation coverage is unlawful and Shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restriction's set forth on his applicati6n. 1. Each'pe I rson'upon whose . behalf this application is made & each person at whose.request and for-w6ose.benefit work is performed under or pursuant to any,permit issued as a result of this applicaton agrees to, & sh - all, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. Z. Any permit issued as a'result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will Subject permit to-cancellatiori. I certify that I have read this application and state that the above information is correct. 1'agriie to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to -enter upon the abovii-meritioned property for inspection, purpdses. Signature (OwnerAg;nt)4 41 w6lzr? - J_�� Date BUILDING PERMIT PERMIT# DATE' VALUATION. LOT 00(14482 TRACT JOB SITE. APN ADDRESS 78-92S VIA V1,0RENCH OWNER CONTRACTOR/DESIGNER/EN INEER MWS MAMMA ALD MEM CONSTRUCTION - 7 F$ ; 9 25 VT& F iMMICE 74360 VELARIDO RD Lt%QTJNTA CA -02253 PAIUM DESM, CA 92260 — (160)773.3-293 CBL# 5102 USE OF PERMIT P001, AND/OR SPA POOL &�'TPA ONLY- ALARMSMARRIERS SHALL HE IN PLACE AT PRE PLA T8 WSPWTION L POOL AIMICIR SPA MWATED COST 01r CONSMUMTON PERWInTRE SUMA"RY PLAN CHECK FEE 101.000-439-310 VD -7 75 CONSTRUCTION M mEc11AN!ctj,L_ PRE - Pool, 101-000-421.000 $24.00 KLIXTRICAL FEE a.1 OOL, 101-000-420-000 $45.00 .4, PLUMBINd FRE POOL; 101.000-419.000 $27.00 i It (7? [�7 0 EfLIB�TOTAI,'COI,fgTR-CTC -flONAkTDP.ICHECK LWS- PRE-FIAM r4= $0.00 t RECEIPT DATE BY/� J" DATE [N�� I JINSPECTOR .10 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 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Footings Electric Bond 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 Pool Cover Encapsulation _ Gas Piping 6 Gas Test Appliances Final COMMENTS: 1 00-1 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) - _ 7 CONTRACTOR cannot assume responsibility, for GENERAL SPECIFICATIONS damage to curbs.. sidewalks, driveways, cement SIZE slabs, sewers lawns, trees, fences,'retaining walls, sprinklers, telephone lines or shrubs. AREA PERIMETER DEPTH When access is made throw a nei bo 's Wm ro it` is. understood that ou d o er TILE CHOICE SO. (om^, 01 J have that nei bor's Armission asme full RBB. N O resnsibifilty.- COPING;' DATE signature POOL CAPACITY I `/ o o o GALS 1 PUMP CAPACITY JS O GPM MOTOR HP ui HP! MOTOR HP HP Iw' a FILTER e - 300c) SO FT FILTER RA / GPM �f HEATER 4SIZE ASO,00a BTU TURNOVER'HRS i } Y �zkJ SUCTION LINESS j X10 (�' - RETURN LINES / /z i SKIMMER MODEL 'u*rj 1 CHECK VALVE GASLINE BY FT. j l ; POOL LIGHT `{ Q S CLOCK I - . ELECTRICAL BY. wC�.T AUTO CLEANER A-fb%,L, N dr i CHEM. FEEDER PLASTER COLOR i DECK BY DECK TYPE io.L ��- STEP FT. SIZE ' RAISED LITE WATTS 100 TRI LEVEL SEATS DAM WALL X FT. DESIGNER DAMWALL TOP SPILLWAY SIZE Z X /2,'4VMDE. - - - - - --- DATE SPILLWAY OPEN CLOSED - 4.-hn I# JETS l IPPFR LOWER Name: Address: Co -*I, (o"1 I:U4-A . .-- -- -A LDERETE -_._ I I t� ;. 9 POOLS • SPAS • LANDSCAPE 74360 Velardo Drive Wk. (760) 773-3293 Palm Desert. CA 92260 Pgr. (760) 833=7632 State Uc.# 331412 Fax (760) 773-3293 F d ;1 .. . - _ 7 CONTRACTOR cannot assume responsibility, for GENERAL SPECIFICATIONS damage to curbs.. sidewalks, driveways, cement SIZE slabs, sewers lawns, trees, fences,'retaining walls, sprinklers, telephone lines or shrubs. AREA PERIMETER DEPTH When access is made throw a nei bo 's Wm ro it` is. understood that ou d o er TILE CHOICE SO. (om^, 01 J have that nei bor's Armission asme full RBB. N O resnsibifilty.- COPING;' DATE signature POOL CAPACITY I `/ o o o GALS 1 PUMP CAPACITY JS O GPM MOTOR HP ui HP! MOTOR HP HP Iw' a FILTER e - 300c) SO FT FILTER RA / GPM �f HEATER 4SIZE ASO,00a BTU TURNOVER'HRS i } Y �zkJ SUCTION LINESS j X10 (�' - RETURN LINES / /z i SKIMMER MODEL 'u*rj 1 CHECK VALVE GASLINE BY FT. j l ; POOL LIGHT `{ Q S CLOCK I - . ELECTRICAL BY. wC�.T AUTO CLEANER A-fb%,L, N dr i CHEM. FEEDER PLASTER COLOR i DECK BY DECK TYPE io.L ��- STEP FT. SIZE ' RAISED LITE WATTS 100 TRI LEVEL SEATS DAM WALL X FT. DESIGNER DAMWALL TOP SPILLWAY SIZE Z X /2,'4VMDE. - - - - - --- DATE SPILLWAY OPEN CLOSED - 4.-hn I# JETS l IPPFR LOWER Name: Address: Co -*I, (o"1 I:U4-A . .-- -- -A LDERETE -_._ I I t� ;. 9 POOLS • SPAS • LANDSCAPE 74360 Velardo Drive Wk. (760) 773-3293 Palm Desert. CA 92260 Pgr. (760) 833=7632 State Uc.# 331412 Fax (760) 773-3293 F d