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0009-012 (RPL)I LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 971(commencing with Section 7000) of Division 3 of the Business and Orofef�gionals Code, and my License is in full force and effect. Li ,,;pse # t o Lic. bass Exp. Date. 656128 C53, 1.0/31/2( Date ' °� 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+1icensed 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 STATE PUNS Policy No. 046-00-00610-0 (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,T, hall forthwith comply with those provisions. Dater ' 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 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. Signature (Owner/Agent) /r "'� `� Date—" BUILDING PERMIT PERMIT" 000 -on DA E i VALUATION LOT (G q�`� TRACT .00 JOB SIT ADDRESS 48-61.4 VWTA PAL OMM0 APN - OWNER CONTRACTOR/ DESIGNER/ ENGINEER x.D- ..D SART DM.LOPW.NT Ct 15)DiaOLk POOLS b SPAS P.O. BOX 1716 74.725 JOM1aME, #A LA QUIN 'A CA 92253 ?AIM BL•S-EXf CA 92260 (760)34.0.9000 CBL* 355 USE OF PERMIT 1>00), AND/OR S'S'A POOL & SPA ONLY -ALARM MAkIMER + SHAM BE IN PLACE AT PPY, PI,F►..S'l'CR INSP CTI01•I.1'OOL t.;(itllRMEN'1 EI^IC1o3C1• e T8 )IoT INCLU I•N THIS PERMIT P40L ANIWOR SPA 1.5,800.00 L $5"A M ATJW COS':P OF C4)NMtrC." 1011 1$,i30PiAt PEi'1' PIR SUMMARY � PLAN CHECK FtE 101-000-439f318 $111.13 COMET UCTION FEE 101.000-418-000 $171.00 tF.� MXCHANIC.AL FEF -- POOL 101.0001471.000 $24,00 L+'LEC:TPICAL FEE • POOL 101-000-420-000 $45.00 � PLCIMO NO FLEE -POOL 101-000-419-000 $27.00 +' Lv S1:3:k3-SAL C,CN•MU(MOR.AND P`�.M OB.CK $378.15 IYM PRE-PAU) •FEM $0.00 fO'S'AL MAM _VM DVE NOW 3'iil.1 RECEIPT DATE ABY" DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION I 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 J BLOCKWALL APPROVALS steel POOLS - SPAS 00-1 Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location _ Underground Electric Final I Underground Plbg. Test Gas Piping _lj — 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 r 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: FROM :-CALIFORNIA POOLS-AND SPAS PHONE NO. _7603465407 Sep. 05 2000'.01:05PM P4 4! s LP,`.3 Y� A RE-INSPECTION FEE Of X30 TY DEPT - NARGE0IFTHEAPPR00 & .SAFE WILL BES ARE NOT t3 i IL ' ' PLANS AtQ lob IRO �v.-ED THE srjE CoA a scH©d No i ,� a DATE . Vit.. _—.._ ___,� � _. �t., � •, FROM CALIFORNIA.POOLS AND SPAS PHONE N0.?: 7603465407 Sep. 05 2000 01:04PM P3 t r . ' • c - ,...':k'+`cam' .. � ;, *:;%.; .,., '..l , s .;} : s • 4 "ria. • • . r "�`. r-mv.- . _ 'VV/.., +,ice::` .1.. .: :: .i,•;;' a � �:.' h. v + - ' -:�', '.-` .�� ya>• ter. !�:� •'; .. • � ... .•7 -'!``...fie!. '9i`. .� '^" - • 't -�, `. 'r ;'•- a' off ..1 ' ii.. .`_ ;.0 _"'"'iii.•Ul ..+.Tiaa,. - ::Z. '. - - , Tk: .:i, � i.C;r � . C _ . . r c - �'�' c 'a• • r1i