9605-057 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm that lam licensed under provisions.of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business andfProfessionals Code, and my
License is in fufl force and effect.
opot 13 Cs3
License # ,; , Uc. Cla' ss r�Ezp Date i0�3119b
Date 2 %' C SignatureofCiSntractor f� .� ?.•
OWNER -BUILDER DECLARATION
I hereby affirm 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): .,' r'
O 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.CYfor thi'srreason
Date l Signature of Owner f J ✓ `f " __ _ , r
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:
Carries Policy No.
(This section nWc7 not be completed if the permit valuation`is for $i Ob' 0 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.l/should become
subject to the workers' compensation,provisio s oflSectiorV3700 of the Labor
Code ,I shall forthwith comply with those provisions..' <' : ; ^ .�.•.>
Date. 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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 applic
correct. I agree to comply with all
construction,,,and hereby authorize,
above-mentioned,property for inspE
and state that,the above information is
and,State laws relating to the building
;sentatives of this City to enter upon the
S `// f LSA' 1
Signahue ' (OV f Data '
A"'
BUILDING PERMIlos.p,57
PERMITS
DATE 5f14J�6
VALUATION S17,4Q10AH3
LOT TRACT
JOB SITE ADDRESS
APN
79-115 ViA SAN CLARA
,
OWNER
CONTRACTOR
IrD DESERTIDEVELOPMEW
79-7:25 RANCHO :LA QUIN'rA DR
Y \\�r
C.ALIFtJ.fMIA 0(0. ,S & Sp
41910 BOA:I�1W , , if.A2
LA< UINTA
PALM . ; �, ,
f7I.SER. f t< .,1260
DESIGNERI.E�glNgERJWcaut -155
(771.)19-41
UGC or r[nWT
POOL &SPA.
FEE DESCRIPTION
FEES
POtOL AN01OR SPA 17,400.0+) LS
C-ST'.I[A9AMO COST or, CO NY f'i2.u.iM1Gl1
17,400.00
4.'EISMT FEE .40A'LA!1.t9RY.
PL AN CHECK FF -6 101-000439.31.8 5.122.85
C0NS'IR:UC1'1Cr'Nlis 101.000-418.000 $189.0(3
NIECEWTICAL FF.S -- POOL 101-000471.000 $24.00
,aUcrRmAL F'£;F --.t)ooi, 1.01-000-4.20-W) $45.00
PLUMBING FM -. POOL 101-M-419-000 $27.00
SLM-TOTAL CONSTRUCTIONAND PLAN CRECK
LESS PRE -PAID .FEES
$0.00
TOTAL PERIM111 FEMS TWE NOW
RECEIIrT
DATE�� j fy! I
BV ` -
DATE RNALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts i
Forms & Footings
Ducts F
Slab Grade
Return Air N
Steel
Combustion Air rT
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
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: