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0012-232 (RPL)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 -^ode, and my License is in full force and effect. License # Lic. Class Exp. Date 6$d 9S C53 04/3012C Date f Z / Signature of Contractor- OWNER-BUILDER ontractorOWNER-BUILDER DECLARATION I hereby affirm under penalty.of perjury that I am exempt from the Contractor's License Law for the following reason: ( ') 1, 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 Policy No. FUND 3"4.��-frit .. (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 provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date:—— 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 fhe 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 or 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 Bead this application and state that the above information is correct. I agree to complywith 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. Signature (Owner/Agent) "-- •* y Date ` BUILDING PERMIT PERMIT# DATE - VALUATION LOT TRACT !/ JOB SITE ` APN ADDRESS 80-416 I=KRA OWNER CONTRACTOR / DESIGNER / ENGINEER Yir i CCS LI C; C ALDOP.k POOLS A.aSPAV . 100 E CII PMAN AVE r lIE 100 74.7,2 5 JQM MY9, #A, ORANGE CA 928136 PALM DESEWT CA 92.260 .(760)340-9000 (MIX, 5386 . ' USE OF PERMIT POOL AND/OR STA POOL &,SP.As&B14Q(ANS1..r'215911�* ©2+ft.X-ALARAi1SMt°al RIERS SHALL HE M PLACE, A PRF PLASTER SM1hili.POOL. EQUIP. 1WwC MC"'d.d0W" IS NOT JNCLUDFD IN THIS PETIMIT. P001,ANVOR SPA 14300.00 LS ILTUMATED (MST 01P CONSTRA7 MON TrKRWr YKIE MiYilYlA.► Y MAN CHECK P&11s 101_000439-318 SUM* CONS1'RMC111014It' F, a0t-000-419-0081 MEG.IMOICAL YEE -.. POOL 10-000-4-21.000 524,019 lrlX&I'L°.idAl,. PER .:, P001a 101-000-420-000 $45.00 P.Ltb'A4Bl'i O ME -- POOL '101'-000.419-.000 $27.00 N ' ` sm- £'cyriv. C':oA1iftig�1'iom AwD Puit; mvcx x:393. Ci13 LES13 1•'111_-'P AID FFFS' $0,00 .d'i •A..C7.d.i 1.9Cr.fAY. 'AAdy. l4.L..(teNVE�'VYY„�'-�arl/F.Y RRC 2 u %Guy RECEIPT DATE ' 8Y DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts FPrms & 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 Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Final Underground Plbg. Test 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 ZF3 Gas Piping Gas Test Appliances Final0 15 COMMENTS: r 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)