9803-053 (RPL)LICENSED CONTRACTOR DECLARATION
<I, herghy_ao.r~.tunder penalty of perjury that I am licensed under provisions of
Chapie:r,.9 (co'mmencing with Section 7000) of Division 3 of the Business and
Professionalstode, and my License is in full force and effect.
License # . Lic. Class ExpY Date
f
d
_
656"128 g3 f'I' / 10/31/98
Date `
1z, `''' 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:
( ) 1, .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 (Sk 7044. Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licerfsed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). g
() I am exempt under Section B&P.C. for7this r as'o
Date �! rr' Signature of Owner,1
u
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 • Policy No.
ST T'1~ '.P UNIT L46-93-0006168
(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 soas'to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the-workers,.compensation proylslonns` of Section 3700f1the"Labor.
Code,I shall forthwith comply with those provisions.
Date '' Applicant—
Warning:
pplicant 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 cancertion.
I certify that I have read this application/and d 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�epresentatives of this City to enter upon
the above-mentioned property for mspectlon purposes.
Signature (Owner/Agent) Dater '
• �S
T.DI DESFRTDEVELOPMEN'i
P-0, BOX 17 16
LA, QUINTA. Cts 92253
US nF PERMIT
CALCFORNIA. POOLS & SPAS
74725 JONI DMVJL 4A
PALM DESERT CA. 92260
(760)340-9000 CBLt# 355
P001L/SP.AJBKi, AL.QMSIBARRMP S _ARE TO BE OPERAT?IONAL ial2iOR.
TO WN-CAP!/PRE PLASTER, INSPECTION ;
POOL ANIS/OR SPA 16,000.00 LS ;
E'S f`IMAYED COAST O CONST R'C• 0*10N 16,91[sU, m
PERMIT IF EE S1rtIV MAt�Y
PLAN CHECK .FEE 103 -000-439-315
CONS`i`RUCVIONFEL3 ".: 101-OOOAIS-000 $_171.00
MECHANICAL FEE POOL l{31 i1i20-421.400 $24.00
'ELECTRICAL FEE -- POOL.' 101k0.60-420-000 $45.00
P:LU`&1BrNG FEE -- POOL 10.1-000-419-000 $27.00
S(IB40TA:L, CTI STkUCf10N ANL .PLAIN CITE-C'K �37b.15
LESS ME -PAID FEES x;0.00
TOTAL PERMIT, FEES DUE NOW 537815
RECEIPTDATE BY DATE FINALED INSPECTOR
BUILDING PERMIT
PERMIT# _ .
fCONTRO L#
DATE
VALUATION LOT
9303-053 TRACT
po
18625 8 6 2 �1
V
sm.(Niii.00
!�
JOB SITE
APN
ADDRESS
79•-080'ViA SAN CLARA
OWNER
_
CONTRACTOR/DESIGNER/ENGINEER
• �S
T.DI DESFRTDEVELOPMEN'i
P-0, BOX 17 16
LA, QUINTA. Cts 92253
US nF PERMIT
CALCFORNIA. POOLS & SPAS
74725 JONI DMVJL 4A
PALM DESERT CA. 92260
(760)340-9000 CBLt# 355
P001L/SP.AJBKi, AL.QMSIBARRMP S _ARE TO BE OPERAT?IONAL ial2iOR.
TO WN-CAP!/PRE PLASTER, INSPECTION ;
POOL ANIS/OR SPA 16,000.00 LS ;
E'S f`IMAYED COAST O CONST R'C• 0*10N 16,91[sU, m
PERMIT IF EE S1rtIV MAt�Y
PLAN CHECK .FEE 103 -000-439-315
CONS`i`RUCVIONFEL3 ".: 101-OOOAIS-000 $_171.00
MECHANICAL FEE POOL l{31 i1i20-421.400 $24.00
'ELECTRICAL FEE -- POOL.' 101k0.60-420-000 $45.00
P:LU`&1BrNG FEE -- POOL 10.1-000-419-000 $27.00
S(IB40TA:L, CTI STkUCf10N ANL .PLAIN CITE-C'K �37b.15
LESS ME -PAID FEES x;0.00
TOTAL PERMIT, FEES DUE NOW 537815
RECEIPTDATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
" Forms & Footings
Underground Ducts
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
POOLS.- SPAS
Steel ! —
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric 7 Z,), -
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 4,e
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
'Final
Utility Notice (Perm)
COMMENTS:
K Q L� �7 Ss
'