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0101-364 (RPL)LICENSED CONTRACTOR DECLARATION 04 hereby affirm under penalty of perjury that I am licensed under provisions of ChLpter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date k �2 1131{2C Date ws Signature of Contractor ' �i 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 thei 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 ofperjury 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. 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. 3TA°fXFW4D 7,29-00-00M$4 $4 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 Sect on 3700 of the Labor Code;" I shall fLdwith comply with thosle•provlsions Date: Applicant — Warning: �"~• Warning: Failure to secure Workers' Compensation coverage ihnlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his F 1 application. 1. Each person upon whose behalf this application is made & each perso whose, request and for whose benefit work is performed under or pursua l It any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuahce of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property foninspection`�.urposes. Signature (Owner/Agent) Date rf� BUILDING PERMIT PERMIT# DATE, 4 �,,. - VALUATION LOT 0101-364 TRACT JOB SITE t APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER C.AH ADAY A— r;;;011fikaA Y HAL.'HA;W.CON dba VAC hTEON;1aC 012 1,7480 E. ).Tal W, 9106 9522PONAM30,141W, TUXI'm CA 92780 1:l.,fCTML V.RdJ FY -CA 9'2..336 ` CM), 246-6045 MR. 4335 USE OF PERMIT POOL ANDIOR SPA POOL, & SFA t°i'Kf." -Ai L,.A,k" ,°'sPJ. RR,'8$ SILA.IA,13th 114 !f?LoA.dr Z AX PR.P W.Tl t IMPEU,1`1'`1OKPOOL. F..O1.t'tk'MENT "C110SURE Is NOT 010"UMID POOL ANTIVOR $FA ;51000.00 14 F UMa 11D COST 011 CX,.) i'S" 1LTC7r'10H' :151MOM 1XI rt OF JlER SUMMARY LAN C" TUCK 'F H)3 8 8105.30 COl+i s'7'dlUCT1' ''YN FEX 101 -000-4 19-000 �:dd3.QC Mx,,CkW,11CA1.1tFE . POOL, 101, �000421 X000 BA.3?&R,1C�.� OZZ, P001, 101.400-420-»000P 01.400-420-»000 *e43.Ot1 Pi.,ir"itsilt'1N0 M _ 11.00L 101. -000.41 �4-000 Tv'00 QW (� Lp EMB- T(Y)"1AL CaORTIRUM, 1014AN3p�pyR�LAW Gf',I3 r1��A�;'K Etp�p ,$3663. /30 RECEIPT DATE BY DAT I LED INSPECTOR O c :1 o,= INSPECTION RECORD C� 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 Sewer Connection Pool Cover Encapsulation _ Gas Piping l 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) • S7,;, r/z2 1:'03:20 7602482919 VACATION POOLS PAGE 02 VACATION POOLS & SP ° % POOL CAPA ITYA PUMP CAPACITY GPM MOTOR HP HP 1E MOTOR HP HP OP CII TGO en er \ SQ��ypN fEEaQeRpVED W11�8 pNaRpE cpRp ARHE��`Ep RENS pjE ICOR p gC SHE S1 nySpEC�14JA0 EXCEPj!�NS! ' 9522 Donaldson Road SKIMMER MODEL CHECK VALVE Lucerne Valley, :CA 92356 <- ELECTRICAL BY FT i AUTO CLEANER .(160) 248-6045 PLASTER COLOR DECK BY So. DECK TYPE (760). 248-2919 FAX SPA SPC SIZE RAISED LITE WATTS M~ic. #C-53-351673 . DAMWALL DAMWALL TOP SPILLWAY SIZE X WIDE CO dam sprin .Whe it is neig DAT RACTOR cannot assume responsibility for ge to cubs, sidewalks, driveways, cement , sewers, lawns, trees, fences, retaining walls, lers, telephone lines or shrubs. access is made through a neighbors property understood that you, the owner, have that bons permission and assume full responsibility. SIGNATURE DATE SPILLWAY :$0168:L ocations { f- tx Bermuda Dunes, Irvine, - California City, Rialto, ± Luceme Valley 1 80.0.999:1811 i ° % POOL CAPA ITYA PUMP CAPACITY GPM MOTOR HP HP 1E MOTOR HP HP OP CII TGO en er \ SQ��ypN fEEaQeRpVED W11�8 pNaRpE cpRp ARHE��`Ep RENS pjE ICOR p gC SHE S1 nySpEC�14JA0 EXCEPj!�NS! RETURN LINES SKIMMER MODEL CHECK VALVE GASLINE BY FT. POOL LIGHT CLOCK ELECTRICAL BY FT i AUTO CLEANER CHEM. FEEDER PLASTER COLOR DECK BY So. DECK TYPE STEP , SPA SPC SIZE RAISED LITE WATTS DUAL LEVEL SEATS DAMWALL DAMWALL TOP SPILLWAY SIZE X WIDE CO dam sprin .Whe it is neig DAT RACTOR cannot assume responsibility for ge to cubs, sidewalks, driveways, cement , sewers, lawns, trees, fences, retaining walls, lers, telephone lines or shrubs. access is made through a neighbors property understood that you, the owner, have that bons permission and assume full responsibility. SIGNATURE DATE SPILLWAY WETS Name: gddres: i TRACT LOT#