0006-363 (BLCK)" '• " - �' LICENSED CONTRACTOR DECUARATION aI ,} -'qf u !
�'!l hereb affirm under , penalty f.`erur ytFiat l am'licensed under. provisions of;�
H �,I 3 Chapter 9'(commencingwlth Section;7000) of Division 3 of the B�usines§ and �vr
ws q CV,r, -P essionals Code, and my License is in:full force and effect
# a Lic Class r Exp:' Date
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Datp°"�G r `'` Signature of Contractorr�'�'�
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OWNER BUILDER DECLARATION.,
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
,f?4� �� : Llcense'Law for,the following reason:. • ,� - • �
.�)Z `A( ) 1; as owner of the property, or• my, employees with wages as their sole
r compensation- will do the work, and the structure is not intended or offered for
I!ra!'Ati,x. sale (Sec 7044; Business & Pro
fessionals Code); t,
:'art � t(r ),sl`,,as'owner' of,the, property,am, ezclusively contractingwithlicensed
contractors to construct the, project, (Sec.,.7044,.Business.,& Professionals --
Ylra ip Code) , ,.,,_. E -
+`fix f O I am exempt under Section B&P.C. for this reason
it f O N "" Date'' ` ' Signature, of Owner
WORKER'S COMPENSATION DECLARATION
o; t , I hereby, affirm ;under penalty, of `perjury one of the following declarations:
? Q: v I have and will maintain a certificate of consent to self -insure for workers' '
X W; compensation as provided for,: by Section 3700 of the Labor Code, for the
a�0 J;J Kperformance of the work for which this permit is issued.
la'�tm;Q
C)!-,4 (7) I have and will maintain workers' compensation insurance, as required by
0 Q a,Section ,3700 of the Labor Code, for the performance of the work for which this
CL I H r permit ; is issued My workers', compensation insurance carrier & policy no. are:
z }, �i?sl1�rCamer Policy No.
i t a i MOOT 9M. PLO'Y'"E 4� Ct+130s6oa a
r.
I J .` _;' (This section need not be completed if the permit valuation is for $100.00 or less).
n OAK„s„ q O I certify that in the.performance of the work for which this permit is issued,
” - n `•'I shall not employ any person in any manner so as to become subject to the
Y �- '..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'thyy se provisions.
Date: %' _Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
Ell 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
't ' of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for permit subject to the conditions and restrictions set forth on his
application.
I' 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 applicator agrees to, & shall, indemnify
hold harmless the City of La Quinta, its officers, agents and employees.
4v 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.
l"g{,�r�'� t ignature (Owner/Agent)
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OWNER •'q� + -a',, - t•
CONTRACTOR/DESIGNER/ENGINEER .r ti--ett i
RY XONE
Ci•A1"ruso
GREG & TF S`
POOL PumBl[�C3,
53-065 AVF' OBREGON
LAQUNTA - CA 92553,
'RFtiUdlaPh'lNC�Q ,�'w'at'C2��w
(7�0)327 759a
USE OF PERMIT
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.12 I.F. 31(HI) CIARDEN WALL(PRONANE TANK. ENCI OSURLj
STAND -MM PER APPROVED PLANS ONLY �� �}' . ;'•� �' i
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CONSTRUCTION FH 101.000.418-000
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SUB-TMAL CONTMU.M-1014 A� PLAN C1'IWIC ~ .
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UM" PRE -PAID FEES-,'
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IMAL 1!'..�' I�MES DUE NOW a �
f,. S` r, , � ��l � 00
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RECEIPT
DATE
f"{�=yS`
i14
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-F. 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
OX 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 BacksElectric
Bond
Footings
Main Drain
Bond Beam
Approval to Cover
_
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING AP ROYALS
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:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)