0205-162 (RPL)a LICENSED CONTRACTOR DECLARATION +
I hereby 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. n
License # Lic. Class Expl to
15`iCs C53 A 13a 20
Date r 7gSignature of Contractor (�f_
g 1W
OWNER -BUILDER DECLARATION
I hereby affirm under penalty 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.
(Q 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 ,�i�:'t#yt i,trJty Policy No. ICtSf?i6£t
(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-1 should become
subject to�the workers'. compensation per//ovi ioins�of Section 3700 of the Labor
Code, Irshajl forthwith comply with ttose provlslonsl/
Date: �yfApplicant
Warni g: Fri ailu� securq Workep' 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�t 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 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 fort inspection.purposes'
Signature (Owner/Agent) Date-✓'�1)r"
V (�
PERMIT02�4,62 _
!_BUILDING PERMIT'
DATE VALUATION LOT TRACT
JOB SITE
JOB SITE
—7
10r 'i � i �4a `
APN
7 �-�tlFlf- D7
OWNERCONTRACTOR/DESIGNER/ENGINEER
HARVEY ENC"rD../9.Nf ER,
QUAISIT HAi?'ROL SS .M..0
W.412R.3V1k1: RA
374W 1iii3li'i'e AY 74
I.AQUIttNTA. ak 922.53
HnOlf CA 92545
(760.0,25 1-7931 amor 6555
USE OF PERMIT
POOL ANDADR RPA
JNSTA11 ATf0_q CM 3?JBER— GLASS SPA PRIt 1090 31753. ALARZM A
SARRIM 1 UETTf BE .IN PLACE PRM, TO VAE-PLASTER;tiil�" OOM
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>9. ANWOR 6PAI 5
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•��t�T1<�Di�
Z"LAVf CliECX MA"t 101 14=43_941 A
NSTRM-MNITE 1014 4I O $41M
itGIi.EU2+ CAS. PRE -VOM 101 49fl-00 Sum
BLUCT'OCALFIRE w L 1.0.X.430"2cow 545.0
7.
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RECEIPT
DATE
BY;
DAT
INSPECTO
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
POOLS - SPAS
steel 11
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
(L/
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
Gas Piping
Encapsulation
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:
,. �/ , / /�/�/� �//
Als-I)K40 IA11 �"/'4�
ised queen palm
sed queen palm
osed queen palm
golf course
80'8
(�[\/� OD 13'3 to rear property line
U o property line
O'S
rear property line
to side property line
Oo' propo spa 1
O�' Q existing grass landscape no changes
o
existing shrubs
property line
f
hou to spa
proposed new patio
concrete aprox 450 sq ft
38'0
property li e
p11a pills
❑ pills
12'
wrought iron gat
existing patio concrete
3 ft tall equipment barter
to
proper
pool equipmen scale -1118" - 1
proposed new sod aprox
300 sq ft
El
q existing residence
existing block wall
?; f?: /• '-11'3-Harvey
Englander
80352 riviera dr
laquinta, ca
INTA pga west
CITY OF LA OL
BUILDING & SAF
DEPT.
AP P ROV
D
307
FOR CONSTRUC
ON i
concrete
existing courtyard no
garage
r
137 43'6-
22;0
823 existing lawn no changes
of block walll
block wall)