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0006-107 (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 myticensA'in full force' and effect License# - Lic. Class i1x' "Date ' Vate f 'd Si.gna�re of Contractor ,d i�.r.'1"f r` �;4I Jt OWNER; -BUILDER DECLARATION. I hereby affirm under penaltyt of perjurywthaI 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). A ( ) I, .as .owner of the property, am, exclusively contractingwith' licensed contractors .to construct _the project -(Sec 704'4;:• Business-;& Professionals Code). () I am exempt under Section B&P.C. for tliis 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 of 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: CartierPolicy No., STATE ,FUND, 1D3d Us�9A (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 workersi0compensation laws of•California, and agree that if I should become subject to the workers' compensation provisions of' Sectiom3700 of the Labor Code, I, shall forthwith comply with Those provisions. i Date: L/'")y" P2i} ApPlicanffT"p.F�1i9LrC �t. .i, ' Warning: Failure to secure Workers' Compensation coverage is unlawful -and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section.3706 of the Labor Code, interest and attorney's fees: IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions*and restrictions set forth on his application. r 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under -or pursuant to any permit issued as a result of this applicaton agrees to, &.shall, indemnify & hold harmless the City of La Quinta,'itsOfficers, agents and employees. 2. Any permit issued as a result of this application• becomes null and void if work is not commenced within 180 days from date' of ,issuance of- such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and'state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes / �-.. . �r /Signature (Owner/Agent) +hs'1rc1A..h••�w' : Date f + �'* J. i « PERMIT# +• WILDING.RERMIT ' .. y107 DATE: VALUATION LOT TRACT C JOB SITE APN ADDRESSCd11,J€,.'bi"T;A. V•['.DF J t -OWNER CONTRACTOR) / EN (NEER PAUL PM, AlymmmPOOL CoNnRiimom 79.37$ CALIX.VISTrAVOME - 73960 W011WAY• 1.13 I'.QU .€A CA 9.2253 PAIN. DESEU C.4 92253-15 (760)'340.2588 CB1.4i 1104 USE OF PERMIT A POOL AND/OTS, S•1;'A ° POOL, &SFA ONJ Y - A1. AxM5W.t•3RR.1XRS SHALL BE M PLACE, A'1' ,?R&PLASTER 1NSPRC 10N. BLOCK WALL FOR P.QUtPMENT ENCLOMuRE 1S'.lC37' 3',�s✓'Ltll�i?J' i�s�d ?i tt5•i'�1t1+E91'4' F ri ' • i FS'X7mAl"I COST Ole Ep 25.0w-00 F1t'+MT1i' FEE SPOWARY ' PLAN CHECK M11 103-000-4-39-318 $163.39 CONSTRUCTION YZE 101-000-118-000 $252.00 ME(MAN1C L FEE — POOH 101-000-421-000 $24,00 ELECTRWAL fit? -• POOL, i, Ol - 000•• 420-000 $45.00 PI. ND1110 -FEE --POOL;* 101.000-419.000 Wool SUB TM AT. C014 iC NOXA1JI91'I N C1WC K $511,80 .V-7.4..1 PF P. ATCi TTZEZ $0.00 !(+OPAL P'M•{ VI EKES _dX N1C► w hs9 4 A . RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans 0.,v.. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation ) 14 LIM Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) AMERICAN POOL'' CONSTRUCT,. 76067494386 yE P.02, � y ; • `..\i}.hhc~~•QY� Ci—��7��� � ate, :, '� At ds 9D r -i f - , S 40 cr • - .t " w .. � f+1 �' � � -' • � . , it � 1 � }' � y,.,. ~ •_ I - 7 4 b!4 777 yyy' x tet• S \ -- •,rf �• "r ,f _ rv, • , x 't"tw 41, r �' a Irl - �;•.,•ti ..� � � � t� - Ali r , ,1'S •`. LP JQ po carQAw AMERICAN POOL;CONSTRUCT. 76067494386 -,P.02AA . ®(a©8(9) WOOS a rth XOS N3U 111 &1 05 it or cn P FF r it (i NOTES. Poo_ y • - - �� -- - _ fila _ � � �. Q - r Cie cc r" / h / e l.:\\I ('Qrr. I rr'1 5' L rt ✓ `f ✓�% �\�/!j ` 3 } t r% ��� `1 J v ! i. 7J(n/ �T QQR.l _ � �j O •� 1 11 / .( � i.k , i v v A h A. t4�)'�, 1'5 ed `jf} ,JL°( h, fir /$ c5:.•.}� - ` . AREA MAP - rD �) �: KEY MAP NO Yl j Lo f 004" f f} I HP CI_ y O,F.LA QUI:NTA. r�r A RE=INSPECTION' FEE OF $30 Bl1;ILDING .& SAFETY ,DEPT. # y = WILL BE CHARGED IF THE APPROVED /q ®V D LIC • rJ l S 7 4 PLANS AND JOB CARD ARE NOT ON` .. CONTRACT SITE FOR, A SCHEDULED. F,QR CMTRUCTION - "cOFFICE– NIMABER THE A' - INSPECTION p p(CEPT10NSl DATe�-C�v NA►t�E 1' (, LOT BLOCK SECS — — -- PRpPEaTY L1 c a1CTION BOX ® HOSE BIB 04 SKIMMER DECK �O�RA1N 3 , TELE vel TELES --'-- -- UTILITY EASEMENT V ELEC• PANEL 08 BLOWER" --- FILL LINE �� LIGHT AREA DRAIN �� AMERICAN - - -�.^_ FENCE (HEIGHT,TYPE) O GAS METER Q VATER LEVELER OF FILTER --+ DR. RETURN == PVC DRAM _ p UUOI - -E-E— UNDERGROUND'ELEC. --+ THERAPY GRAB Rads �= f.,ONST�IlCT10N BENCH MARK REMOTE WLVE UH HEATER P. 0. BOX' 11996 —G—G— UNDERGROUND GAS PALM DESERT CA. � WATER DEPTH GATE VALVE D MAIN GRAIN –•1 AERATOR LADDER –�–( OVERHEAD ELEC. ® ® I OVERHEAD TELE. R _> = SWITCH © P TRAP C> PUMP,,! ® � GAS GRILL (760) 322- 666 /996/996AN ® ELEC. PEDESTAL ACCESSC� 0 RECEPTACLE --3 STUB & CUP ANCK)R & SEE NOTES