0005-280 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby, aff1 m ender 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 _# r _"' Lic. Class Exp. Date
'351673 C53 �2137B2t
Date I �1Signature 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 t0 construct the oroiPct (Ser. 7044, Ri.Isiness R Prof a_csion.als
Code).
O' 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
Sec 'on 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 WND Policy No. 229.0-00193N .
(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 beco a subject to the
workers' compensation laws of California, "and agree't iat JifI should become
subject to the workers' compensation provispii rts' of�ectioA 700 of the Labor
Code, I shall forthwith comply with th °se _p� �ision,s'�
Date: f " ' Y 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..Stat7' I.ws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property/for in
sp
ec
tionpu oses.
Si nature (Owner/A ent) % �! I•' Date `
BUIL-DING PERMIT PERMIT#
DATE{ t p{ELOT VALUATION % 5-2W, TRACT
Z3
�j $1440'.00
JOB SITE _
APN
ADDRESS 7_46,,30 iVI.A.Aj().f;i,�'�'a�.?in
OWNER
CONTRACTOR /DESIGNER / EN INEER
CAVA �3AY & COMPANY
F .V, flM9 q �X dba VA.CA17014 POCiU
174.80 7E. 17M `V. , 0106
9522 DOWALDSON;RD, -
�7:5'�YW CA 02780
1,V1L' RNR VA1:EEXT CA 92356
.(909)248-6043. CBZ fl' 4335
USE OF PERMIT
POOL ANWOR EPA
POOL2SPA ONLY=11iRxiaARtJERSSHALLFJE)17PLACE AT
Pi&yyaANTftyESPECmION. POOgEQWfCySH sN4LJJVkNOT
INCLIY DFD M THIS PERMIT.
VALUATION 14,90a, 001,.9
3 S",i:SWXffX (,40$r OIC' CONGIMUCTi:ON
14,09MO(D
1;' FM GWOMAIRY
•PERZirii r...s
PLAN CHECK F1 E 101.000-439-318 $99.99
:,CONS P"UCT10`tx PEF, 101-000-418-0'00
MIr,,CFI *HICA.L FWK •- POOL 101.000.421-000.
":
s•~Lt t✓"i'1LIClit. IMM,-- POOL 101-000-420-000
Y. S
.
ti
>?a.c�Marr�� FEE- POOL io1-009.419oCi00 �27,a�'
1
�.{fl,t
'
yea
RUTS- I'OT.AY.,Cf5itlMI UC,"110+N .AM PI -M CRE CK
$348.41
7.13su PRB -PAYD FF"?
T'OT.A—L PMffr rc+ S WE NOW
4 6.45
;�-._
RECEIPT
DATE
BY "
DATE FINALED
INSPECTOR
1
OPERATION
DATE
INSPECTOR
OPERATION
F DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set B ks
Underground Ducts
Form & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX 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 We
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
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) '
VACATION POOLS & SPAS
r ` 95Z2 Donaldson Rosi
fY OF gyp, OUINTA r
A RE-INSPECTION FEE 0 ROVED a l.uosrnaValley, CA 92356
BUILDING & SAFETY DEPT. V01tt BE CHARGED IF THE APP t�cE .(700) 248-6045 phone
®v ® PLANS AND 10B CARD ARE NOT ON - - (760) 24&•-2919 fox
APR THE SITE FOR A SCHEDULED �.i-fC-53-351673
FOFi CONSTRU 10 - INSPECTION. s. - Sales •LACatfons
A EXCEPTIONS!
_ Bermuda Dunes,.Irvine,
'DATE`S BY - California Cite,` Rialto, •
-- ,
•
- � • .Lucerne, Valley
(5w) 9"-1 all
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44. X abs
• r � � � � � .. AREA PERIMETER
REM 5-
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CHOICE
COPING
FOOL WAC" GALS
MOTOR-HP HP
..
POOL MOTOR HP HP
. l L Y 5�. •- FILTER SO FT
4 . ` . ' ♦ •. HEATER SIZE B'EU
a .'�;N► ll _ _ _ _ - 'f _ a - CHECK VALVE
GAM ME BY FT
CLOCK
ELECMCAL EM FT
,j • - • d' • ° f : ` a DECK ' t �� • a• . 1 - -
CMEX `fin t� fitsp
• •* . r i ' . • _ • f
i • < - ° • - . ' . • : ` . ~` . r PLASTER COLOR
a �..ID-EM TYPE
- � t✓� � •� • - _
STEP PQCs. FT.
A . •
SIZE '7'
�8 r
Q, P� LITE WATTS
DUAL LEVEL SEATS
VAMWALL
RANWAIITOP 4u4v-f71 �
SM X Iff WIDE
SMLAMCOWRACiDR cannot assume neeQotm3bilLy for DATE AY S
1 _ BMW SOWN&. lormbase. lancesfance k reb*kq "k }
? s� %a Or .-vh nj & h C
� �daors s merle ttrovgh a neighbor's p�p.rt�r `( _
f it is underetnod *at You, tfa Mnsr, have that Addroas: • 3D - 'a
aigl Ws Wff ireicn and assume full rwwwbVy- 97 �2 lit , /x(o N ��
DATE VPM=7,.&" TRACT: �d ' L' Q LDT J R _33
- = S IGNATU RE