0402-183 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under 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 # Lic. Class Exp. Date`
fa5£rl2sa C53IRCtt°;'I
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 contraciing" with licensed
contractors to construct. the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Sianature of Owner
WORKER'S COMPENSATION DECLARATION
1 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.
--U—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.
STATI IS COMPMESAf I 046-6168-204
(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 Sec ion 3700 of the Labor
Code, I shall forthwith comply with.those provision's.
Date:! ,.r 1.r3 f 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, indemnity
& 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 alli City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertlforeinspe ion purposes /
Signature (Owner/Agent) Date
PERMIT #
BUILDING"PERMIT
DATE VALUATION LOT 04'&2-1KA TRACT
JOB SITE
APN
ADDRESS�'dd^ i. �t t e a�1.r6 p97 t rte
.,3a7•^.�.�.� FA.en'R.u.t^%�YZ. SJ`�.i. v.c.
•. ••
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Iiii^ci IE F10MIS
CALM'ORICA POOLS BSc. SPAS (TOP MAY CC
5 Ii, CUM AV', ML 205
66-3 00 AVrW.(Y.F' 54
R1°1>1 A. TTS CA 9257;
COACHEX,LA. CA 92236
('I�.Csj39F3�9y2� C Lf# 00355
USE OF PERMIT
POOL Air DIOR SPA
PfJf;SMPA, itJ,4TLkR.FTA.TURE 86Q(AW 31721.52.190 FIR.S,P"IT
(496AOAL),A AAT`tMSMARRi[ER9. SHALL BE TN PLACE AT 3'R&PLA.STER .
INSMTION. EQ'U1PlVENT MCLOSURB'NOT INCLUDED
P0010 JWDJOR SPA 20,61), Do Ls
9MATi::1'➢ CO "1 Ort C°-OINFI'RUCTIC):LN
i3fi3i?9�i1!Gi
PX.RNUT:"1i:1i; SUMMARY
PIA14, C-`1•lECK FEE 101.000.439.313 $13.4.;55
CONSTRUCTION FEE 101-000.418-000 $207.00
>tJIF4Fias ICAL FFE -- POOL 101.000.421-000 $24.00
LLECTRUULL VIEW, — POOL 101.-000-420-0Q0 '$45.00
PLtlM331 O t7UM.., POOL 101.000=4.0.000 $J` Ala
LQ �
D
FEB 2 0 2004
CITY OF LA QUINTA
SUP .;�t'lTAL C O' . v f. A , : PE ..T _ : __in
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LESS PRE-PA1i)�fi"J✓,a
TUMFERAMYERS I ITE NC)l>1►'
X437.
RECEIPT
DATE
/. let c.
BY
DATE F LED
INSPECTOR
�./
Z o-
lp
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 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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Qi p
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)
i
SPECIAL INSPECTION SERVICE
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
O REINFORCED CONCRETE UCT. STEEL ASSEMBLY ❑ -S000p
O POST TENSIONED CONCRETE fO ASPHALT THER et-4PERFORMED O REINFORCED_ MASONRY O FIRE PROOFING
JOB LOCATION
l c`�li
LA �VL��
REPORT SEQUENCE NO.
TVPFQF j1�TURE-�^,
\.i
PERMIT NO.
c]�'
ply_
Q
DAY OF WEEK
MATERIAL DESCRIPTION-3
03
ARCHITECT
I ' PE y R
NRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSCTION
DATE
GENERAL sue
CONTRACTOR CONTRACTOR s
*-QS � LN
011OX131 Co
Co"
%A► 0
�..• A . c t L% 66
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
'HEREBY CERTIFY THAT 1 HAVE INSPECTED TO THE BEST OF M1
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
IGN TORE OF REGIST IN PECTOR
9
03 0 bay