9612-048 (RPL)LICENSED CONTRACTOR DECLARATION
I herepy a,firm under, penalty of perjury that I am licensed under provisions of
Ottapter 9 (commer cAng with Section 7000) of Division 3 of the Business and
Professional'g Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Datel Signature of Contractor > -, 10 /'/
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors
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 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.
lf..AXE FUND 1423735.96
(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 sha I foJ?hwith comply with'those provisions.�
Date: !•%� /' Appli int ', . -. •.%�-�°!�✓.'"/ti„,."�.,
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".) D.r.�. � D��/����
PERMIT # CONTROL #
BUILDING PERMIT 9611-048 4445
DATE del �.£ VALUATION : LOT TRACT
JOB SITE
ADDRESS 78-."%V 1[ SONATA APN 1,0T-
7 -
OWNER CONTRACTOR/DESIGNER/ENGINEER
MIKE %ltlii�I,;�Fi1�7s,�w N 1'
78-553 VIA (YN A i'A
LA QUINT'A
I USE OF PERMIT
eol Al A -Mpl Ottly
POOL L ANWOR 31-A
CA 922753
LfNf ,X111+,'_��'cfg3OL':-; BYCA_R,%,T1 Tr
74818V
PALM DESERT eik %no
(GIi )1W6�i35 G;13L9 1366
i3t?►1.OU LS
.11 14
toffy'CHAN1C A1. rrlE IOWWO.421.000 5214,00
fc'f'.4?101.000-4420-06,36,.) $45.Go
PLAN S93,40
(Xi+^7S'1'RCJC]'ION IT% 014lik4l4-W) $1-i4.(W
,. t3�Ic InA t, CQNST1tUC'7'TC:)AI AND II,AN C1iFr-K
LESS PRE -PAID FEL
DEC 0 5 .996- ,. 'M, FR, 011 CN . $33314)
RECEIPT DATE BY DATE FINALED INSPECTOR -
rn
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 Wail Insulation
Condensate Lines
Party Wail 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
Underground Pibg. 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
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:
pare la quin'ta
PARC LA QUINTA'HOMEOWNERS-ASSOCIATION
AVAIL PROPERTY MANAGEMENT
P.O. BOX 1032
PALM DESERT, CA. 92261
(619) 568-2717
,City,of,La Quinta
-ja Quinta, California
ARE
TO WHOWIT MAY CGCqCERN-
,Unique'.,Pools has been hired,to-install a' pool. at th6'above',-'-
ref-erence location.
The Hoai6owners Association.approves of this -installation with
the understanding ..t:ne side'viall/gate will be re -'constructed
in the.exact location from which,it was removed and with' --the
-
.same-or-similar materials.
"AW
Further Unique Pools will clean' the debris from sight each
IN,
night before leaving, andno heavy equipment will be left visible
I s.w4
1R.
to the street.
Should You have any questions,'please'contact this - office,
Sincerely,
Cam Anderson
Project Mgr.