0008-309 (RPL)LICENSED CONTRACTOR}DECLARATION
!!°here 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 my License is in full force and effect.- --, J
License # Lic. Class Exp1Date
x»574127 A.
Date Signature of Contractot°''1
OWNER -BUILDER DECLARATION
I hereby affirm under P.enalty of perjury 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).
(. ) 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 STATE FUND Policy No. NO -00.0007934
(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
workers' compensation laws of California, -and agree that if I should become
subject to the workers' compensation provision hof Section 3700 of the Labor
Code, I hall , orthwith comply with o e,prbvisions..,
.Date: —r,, 'PUApplicant
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 hi6
application. `'k, q
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 tot
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 application and state that the above,information is
correct. I agree to comply with all City, and -State laws rel,ating'to.the building
construction, and hereby authorize representatives of this Qty jo enter upon
the -above-mentioned property for in`specfiompurposes
Signature (Owner/Agent)�' •- ;Date F.-
BUILDING PERMIT PERMITN
DAT � UA ION LOT ZT467r '
+
JOB SITE d
ADDRESS
APN
OWNER
CONTRACTOR/ DESIGNER / EN INFER
BOB & XUDY SPAIM
S'i'WE 150I?SON 0013 1tU;01111ON We.
95.003 RIVIERA73011
COUk� MY C-11 3 tiI�;s M)YIE 7F4
I.A Q-LUNTA CA. 42257
PALV Dh'SrU7'-. '1' Caws 042260
(760)346-4032 '-G`BW 1044
USE OF PERMIT
POOL. ANYOR LIPA
P00L & SPA ONLYAI " M SAIARM ZR3 SIiALL, if IN PLACE AT PXZ
PLASTER rNSPECTION. POOL LQUIPIt+lENT ENCLOSURE ISI NOT DICLUDW
IN THIS PERMIT
POOL A131WOR SPA 21,794.00 is
fi-ISTMAD CIOU OF CONSTRU('°1°CON
21,7 .00
pErMU, INT SUMMARY
i'1.JjW CITY PEE 101.0004439-318 $140.15
C OINSTRUCTION FEE 101 •;000.4113-001 $235.00
MEC1F NNICAL RRA? -- POOL 101-000-421.000 $24,00
ELECTRICAL FEE -- POOL 101-000-420-000 $45,00 '
PLUMBING FU -- P001J, 101.0€10.414.000 $27.00
4
-'i'O`�1 : �01"a:�"LRUC'�AC12� `,23x] P� ..1�I' C1T fi
$467.25
L %X,83 Plib:PAIDM21
$0,00
�
nGG � � r'�xt L PYA&l �ry 8 D NOW
447 '
T' �}�
RECEIPT
DATE
B
DATE FINALED
INSPECTOR
a
.VS.,
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
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
POOLS - SPAS
, /�
�'SLU
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
/d
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
/ 6
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbctures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: