0010-0278 (CP)47750 Adams Street
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.
License # Lic. Class Exp. Date
Ddte q Signature of Cont
OWNER -BUILDER
I hereby affirm under penalty of perjury thatamsexempt 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.
(4,,,)/ 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.
LEMON M'URA1 #O& 15009 1
(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 i Irsheuld become
subject to the workers' compensation provisio r s}of Sect 700 f the Labor
Code, I shall forthwith comply Ith those roylsi9ns .
Date: Applicant . p 1 f
VWarning: Failure to secureorkeks' Compensation coverage is unlawful and
shall subject an employer to 6 imina `tpenalties and civil fines up to $100,000, in
addition to the cost of compens tion damages as provided for in Section 3706
of the Labor Code, interest and a ney'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 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 represeota, t've's of this4City to enter upon
the above-mentioned pr6 erty for ii pe on 'Kposes'l"
(Signature (Owner/Agent) q 4• - Date
t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
Yt?PX1.
JOB SITE
APN
ADDRESS
47- 150 ADAM N
OWNER
CONTRACTOR / DESIGNER / ENGINEER
TRE AU08 C'Oix.PORA1701q
`IR ;Pi4ltiDOS C"OR:ff<)I :A' OW
-5X29TA.1+dlXMIAA-Z„RIVEMME,92507
92507
CA 915207 -
WO=TON CA 952W
(707.)73,3-3930 C'B3.41 59016
USE OF PERMIT
COMMMMAL
COMMERCIAL POOL. AS PER APPPkt3V10 PLANS
POOL Ali3DIOR SPS, LS
s
EMU= COW OF C'Q3N:SMUIC110N
6010W.00
F'i. FEtTVIARY
PIAN C 90K We 101 dOtJ 439.316 $29010
CONSTRUCT .M.MCF, 101-000-418-000 $453.50
011 ^Ce042t-Z0 $4.09
MM .1CAL PIZ .- POOL 101-000-421-00
L2A ryPJr vL. dM. POOL Q01-01--4dj'000 $0.0
PIUMBINO ITT.:.., POOL 1071.000.4.11a.;000 $27,09
OUB- t rAL 4rON S71. MI CI3 SON PIA`CD Med'Yn 4rI7.rJ1: K
$8501,18
MRS MR-PC47t.T.i AM
$0,00
",i UTAL PMMITIMS DUZ NOW
11111111 IN 34
IE
RECEIPT
DATE 1) `j
BY
DATA/Ef FlDiALE,16
SPECTOR
{
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
.DATE
TINSPECTOR
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 Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs r
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric.
Underground Pibg. Test
_
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
4
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
-,Temp. Power Pale
AJ ground 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: