9707-031 (RPL)LICENSED CONTRACTOR DECLARATION
I herebv, affirm under penalty of perjury that I am licensed under rovisions.of
,-,—Pfd 9 (commencing with Section1000) of Division 3 of -tee Business and
Professionals Code, and my License is in full force an ,effect. .
License # Lic. Class Exp. Date .
/Date ��D Signature of Co ractor p
OWNER -BUILDER DECLAIATION
I hereby affirm under penalty of perjury that I am xempt from the Contractor's
ucehse Law Tor the tuunwing 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 (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).
O 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 37.00 of the Labor Code, for the
performance of the work for which this permit is issued.
(X) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the. Labor Code, .for the performance of the work for whicri this
permit is issued. My workers' compensation insurance carrier & policy no. -are:
Carver Policy No. .
(This sect on Need' NO be completed if the permitv� ati, n stfor $00.00 or less).
() I certify that in the performanceof thew rlZfor which this permit is issued.,
I shall not employ any person in anKprovl$l
m er so as to become subject to the
w ,kers' compensation laws of Caliand agree that if I should become
Gbject to the workers' compensate' ,�ons of Section 3700 of the Labor
ode,.Ji al f�q a comply wt1� those pkv i- `
Date: Y pplica
W
Warning: ailure to secure Workers'Compensation coverage is unlawful and
shall subject an employer to criminal pen hies 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 ap
correct. I agree to comply with
construction, and hereby aZ1,
t 4 above-mentioned prope
Signature (Owner/Agent) _
and state that the above information is
and State laws relating to the building
,esentatives of this City to Met upon
"n purposes.
Hata . 4
"I
,,BUILDING PERMIT PERMIT# °°NTR°`#
5 O'S
DATE ii VALUATION LOT' 9707-031 TRACT
/1 1
i f 7ifPi'i. �
JOB SITE
APN
ADDRESS
' 70 V11A J01A DRIVE,
_ 7 e
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ARMSTRONG
FAR:TILY POOLS CONSTRLIC'nON
-14-170 VILd.,i 'IW:0'[i.
5-13W ANTNIDA [Lt":t[RIMY
LA QIJIMI A CA 92253
r� t�iJINTA CSA 92653
!l.
(7,60).5(Y1--3655 CBL" 2993
USE OF PERMIT
-4,
P00L AND SPA ONLY
POOL ANDIOR SPA 16,700;00 'LS
tell ":IMA71ED CION' OF CONST RUCTION
116,700.00
PERMIT JrmSuhotcky F
PLAN CHECK ME 101-060"4139-318
CONSIRILI BION FEE 10,1-666-418-000
1\41ECHAMCAL FEE'— POOL- .101-000411-wo $24•00
ELECTRICAL aEC7 it lS A.L Flrl ...YOt?1. 101.000-420;000 $45.00
PLUMBING r -= POOH. 101-000-41 o-Ot?0 $27.00
d'-
r •
PAI J8v'!'C> 'PLAN
rALS C:O1NS rRQC`fION C1.1ECK
$393.00
LESS PRE-PiUD 1:EUS
S0.00
JUL 18 1997.
'fOTA], PERMIT VEWDUFNQW,
$393.00
g
RECEIPT
DATE
BV .
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
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
COMMENTS:
r
� "��
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)