0308-013 (RPL)LICENSED CONTRACTOR DECLARATION.
I hereby affirm undef penalty of perjury that I am licensed under provisions of
Chapter, 9 f 6omrrier1cing 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
79222j5 B
,/Kate+ /; +Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from 16 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 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 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:
Carrier BX;l3MP'1' Policy No
(This section need not be completed if the permit valuation is for $100.00 or less).
( Z, 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 Section 3700 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 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 Zommenced 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. h R
Signature (Owner/Agent) `Date r
V
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �'��� TRACT
OsM4/20§3 $5, ,00
JOB SITE APN
ADDRESS 51-9' 5 A%rF.Xn) i� OB"KGOK
OWNER CONTRACTOR / DESIGNER / EN (NEER
LIEMPM3 L" LEONARD 1.,,W
111 CI -lm MA C MOLE 111 ('ID -MMA CMME
PALM SJ RT C.A 92250 PALM TMEWr CA 92260,
C/60)340-9882 0741# (A-26
USE OF PERMIT
:@OO.T.. ANWOR SPA
ADDrN'G SPA TO PC0Of, Ad:Ei12MMtkiA.Ii1tII 3 SliALL BE IN PLACE AT
PRF PLASTERDMPIXTION CQUIPMKIT 1<NCLOSUAE140T INCLUDED
100 I -F. 6' HIGH BLOS:K WAY -1, ::IT -T STV413A1•tD
POOL A.AIt?IOR SPA
6 Fr. WALL,
310@0,00 L8
100.00 LF
E.STJMA'.t':I D COSIOF COIN Ud:` 1.ON
MMIT FEE SC'ilaL A4AIZY
CONSTRUCTION FEE 101-000.418-000 $81.00
MECHANICAL FEE -- POOL 101-00"21-000 $24.C*
ELECTIUM IEE -- POOL 101.000.420-000 145M
PL UMBINCI IPEL.. POOL 101-000-419-0CX $211.09
TL
i�l AIF31'l�1TL"1'fUY�T AND Fx.�T L'%CI�
may, -. �s�, 1ESS PRF_ -PAM .FFr
� V A1(o 1t'. IR11' FKEN 1??TT1?: N0W
t J
j1 RECEIPTI DATE U n I BYST
,-,-. I DATE FINALED I INSPECTOR
515M.00
.00
$1",00
$0.00
$177,00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE j
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
t
Slab Grade
Return Air
i
Steel
Combustion Air
f
Roof Deck
Exhaust Fans
O.IC to Wrap
F.A.U.
r
Framing
Compressor
Insulation
Vents
I
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
Set Backs Q
Steel/
Electric Bond
lj
Footings
Vk
Main Drain
[
Bond Beam
_ p
Approval to Cover
i
Equipment Location
[
1_74)k<Underground
Electric
�l U
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
a
Electric Final
[
Waste Lines
Heater Final
[
Water Piping
Plumbing Final
[
Plumbing Top Out
Equipment Enclosure
I
Shower Pans
O.K for Finish Plaster
[
Sewer Lateral
Pool Cover
[
Sewer Connection
Encapsulation
[
Gas Piping
{
Gas Test
{
Appliances
-
[
Final
[
COMMENTS:
I�
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)
Plan for:
pool at
51-885
Avenida Obregon
La Quinta
Nomonui-sNO0,H0a��o�ddd
�
�.1
N MI
T,
V 0 VJAOI
INin
7-4"
3'
7'
A elec Plug.s
10
From
rom
waters edge
18" opening to pool
TO
;0
OF
4'
1816"
...............