0112-006 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of 17erjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000)rof Division 3 of the Business and
Professionals Code, and my License is In full force and effect.
Llcense # Llc. Class Exp. Date
Date ,f �' ` �� ° Signature of Contractors
1. V
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 , 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(;) 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 ST4TF 1.�11UNDy Policy No. 1615074-01
(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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those pp• ro7iop� s.
Date: p/w -"• r Applicant p ._ t, 4-`f.�.�,e
.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 City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
r
Signature (Owner/Agent)y t-" rbF Date C�
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
12t�.1grs,oc
JOB SITE g'O5
APN
ADDRESS = VIAS UNDA
y
OWNER
CONTRACTOR / DESIGNER / EN (NEER
GARYSTAIN&.sar�t';Q�t�'%T�'�tli'i"1�0N
G.fir i 30 POOL PILTY 0ING, INC
48.7! 85 VI. �ri.a`ts).A
667 BUCIME 1d).
U. QjAln-A CA . 92253
PALM Mi;tNGS CA 93264
USE OF PERMIT
POOL .14ND/oR IURK
)aOC,aLASPa ALARM Wi3AiWXRS SHALL, RZ 114 PLACE AT PIWPLA1:.'I'f�•1�.
II IVEROTION, I1001, PQTURVIENT KNOL0ii'1,15 ir: klc, T WO)JUMD.
P0011601,0JOR, 5 PA Q,00101) W
C0 ' 011 i`ONS'I'%t'i.,S.'"1:7E: X
171000 ,00
Y.'"3"HAAUD
K.'N CHWX Tru 101-000,439-318
t l!I.a'I'lt.f.3 '".PY ki ir6Z 101-000 418-000 baa .l
7E'i n.timic" T, FFE, -• V001., 101-000,-4z 1.000 $24.00
2L.t'*P,'C"'M1S.A1.Ft1W VIM, 101-000-420-000
P.i� � I S�Iv�i "P1?� • F° C!1. 101400-4 13.000 : r' S�s''7M
OFC 0 3 2001
C11YOF LAQUINTA
FIDE DEIN
ALL t`:ommm.ITm"(014T 4''v, To Z°IAW, C1111CIC
$393.00
i
DUE, 11101W
RECEIPT
DATE
BY
DATE FINAL 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
POOLS - SPAS
BLOCKWALL APPROVALS
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
�( d ?/
COMMENTS:
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)
FROM : GATTUSO POOL CORP FAX NO. : 7607784920 May. 29 2002 04:05PM P2
GgTTuso
POOL
coRPoRArion
A D1VERSIMED SPECAL(ST COM W 667 EUGENE ROAD • PALM SPRINGS, CA 92264
(7601327-7592 • FAX (760) 7784920
May 13, 2002
City of La Quinta Building Department
P.O. Box 1504
La Quinta, CA 92253
RE: PERMIT #0112006 -REQUEST FOR ADDRESS CHANGE
To Whom It May Concern:
The above mentioned permit was pulled for 48785 Via Linda- This is the home owners (Mr. &
Mrs. Leverte) current address. Their new home is at 48805 Via Linda. This ne, - address is
where the house and pool is under construction. The permit #0112006 should have been pulled
for their new address not their current address. Would you please correct the address on this
permit to 48805 Via Linda.
If you have any further questions please feel free to contact our office.
Thank you for your time and attention in this matter.
Sincerely,
ID� —0�
Gary Gattuso, President
Gattuso Pool Corporation
GG/jc
IAISO* POOL' ORPORATION
667 EUGENE 'RO.-
PAM SPRINGS, CA S22.94
OFC (760) 327-7592 W (160',171B420
LICENSE # 672850
IRE -INSPECTION FEE )F $361z,
CilHARGED IF THEA PROVED
3 i -M JOB CARD ARE NOT ON'
SITE FOR A SCH WED
"TION.
.NO EXCEPTIONS!
Al?tqr`
CITY OF LA QUISTA
BUILDING & SAFETY DEPT.
AP MED
v FOR CO=UCTION
DATE By