0212-106 (POOL) LICENSED CONTRACTOR DECLARATION " PERMIT#
I hereby affirm under penalty of perjury that I.am licensed under provisions of �BUIWING PERMIT
H
Chapter 9 (commencing with Section 7000 of Division 3 of the Business and L "��
P ( 9 ) DATE VALUATION ,y LOT TRACT
N W Professionals Code,and my License is in full force and effect.
License# Lic.Class Exp.Date
LUJOB SITE
r 6561.128 C5 3 01 . � 1 . 1IN ADDRESS 80^• &A,'t%NVk' APN
t*- r— OWNER CONTRACTOR/DESIGNER/EN (NEER
C ZO r r�Date Signature of Contractor .f � - -• '
o �c.�"�1.431�E SE � C x+ 'T�.uI P001".5�'.SPAS(M.P MW CG^Y30
H OWNER-BUILDER DECLARATION
J U co 80-209,fad MM, 3+�5C ^100 A't�XNU;�5rA
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ,,, �, , , ,��
~ a License Law for the following reason: Ai&QVIVrA CA {a'`253 C'�;p',�'�"�'`Ee�A 92112 36
Z_ ( ) 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). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed 1000LANDIOR RPA p'
contractors to construct the project (Sec. 7044, Business & Professionals `
Code). POO'"<1101i'(,I :A 1I a},25 L.F. 5'S;..QCK'fAALI,C1 Y
() I am exempt under Section B&P.C.for this reason STANDARD,
N Date Signature of Owner std',;1�YtiSY'310
ON
C�
Q WORKER'S COMPENSATION DECLARATION
p Z I hereby affirm under penalty of perjury one of the following declarations: ,
Lo H O ( ) 1 have and will maintain a certificate of consent to self-insure for workers' '�FT.0 110 29'00 L-S
X W � 'compensation, as provided for by Section 3700 of the Labor Code, for the
irOC�t'AtL?ffkP'PA �i,4 �'fllf �
O � JQ performance of the work for which this permit is issued.
M Q'C) (� I have and will maintain workers'compensation insurance,as required by
O U QS-ecti�on°�3700 of the Labor Code, for the performance of the work for which this
d 0 H permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Carrier k'€.A FF t"���F�133,A'rI Policy No. �#$+��Eti�tR�+�d JUIE ��+. D r+C?�`.C'OF� �1.�' '.{:.&T11 1110-I''� 25,000.
ob O
prouff te a;SUMMARY
g (This section need not be completed if the permit valuation is for$100.00 or less). PLO!CHECK 110 10'1.00'0,4'.49-31.8 $10103
( ) I certify that in the performance of the work for which this permit is issued, CONSTI RUCT[014 FXX 101-000.415••000 $23,930
1 shall not employ any person in any manner so as to become subject to the 'MSGANICA,f.2�C�`F nOL 101.000.421.000
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor Et.#rC"i C'ft" l I .� tC9L 101-000-420-000 t:5.r10
Code, l shall forthwith comply with th s. provisions. F�C�'i:7l�b13040 FRE PON., 1.9
1000.419.000
Date: g` Applicant—
Warning:
pplicant Warning: Failure to secure Workers'Compensatio 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 his
application.
1. Each person upon whose behalf this application is made&each person at 'RUB-!"ITAL C6 TVTEVUM10NTA1 PLAW'6,lrY,ROX 1122.1.5y4
whose request and for whose benefit work is performed under or pursuant to [%CITY
Ud,�n 1,,�;�-.�,IAM 1'.G�'R�t.`� x€.,.00
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 1��3�:��.!f 1°zl"l):UPSDUNNOWwork is not commenced within 180 days from date of issuance of such18 10011permit, 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 LA QUINTAI�IIIIIIIIIIIIIIIIII513correct. I agree to comply with all City, and State laws relating to the buildingCE DEPT.
construction, and hereby authorize representatives of this City to enter upon,, IE
the above-mentioned property for r spection purposes. `7
/ , RECEIPT DATE BY D FINALED INSPE
Signature (Owner/Agent); T' r,*.. D to✓ `'� �24� f� x rr r+'? 1,'1 l/
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 Wail Firewall
Exterior Lath
Drywall-Int.Lath
Final
Final POOLS - SPAS
BLOCKWALL APPROVALS Steel _
Set Backs Electric Bond J
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Plbg.Test
Final Gas Piping G/
PLUMBING APPROVALS Gas Test t
Electric Final
'4 aste Lines Heater Final
°Nater 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 _ C
Final
COMMENTS:
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)
IIIIIII I I III VIII III 59 4
'ENo. 1222 .
' P.O. BOX 1504
Building $0-209 Ave 50 78-105 CALLE ESTADO
Address LA QUINTA,CALIFORNIA 92253
07e' .th $ease
Mailing BUILDING: TYPE CONST. OCC:GRP.
Address Same
A.P. Number
City Zip Tel.
La .ltti-xata, GA 92253 564-.4599 Legal Description
COW t Reese General Contractor Project Description 335' of 6� high garden wall
Address
Same
City Zip Tela
State Lic. City
&Classif. B1 15610Lic.`# Sq. Ft. No. No. Dw.
�► �...C. Size Stories Units
Arch., Engr.,
Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Address Tel. z4
City Zip State
Lic.#
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section
e000)of Division 3 o h ,8usines`s•and Professions Code,and my license is in full force and
ffect. ` � �
SIGNATURE _ DATE;
t—
OWNER•BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractor's License Law for the following $8,375.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a ;
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to lila a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law„-Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that.he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep.
subjects the applicant to a civil penalty of not more than five hundred dollars($500). Plan ChkBal
O 1,as owner of the property,or my employees with wages as their sole compensation,will . .
1
do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. 3 ��
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees, ,Mach.
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner-builder will have the burden Electrical
of proving that he didnot build or improve for the purpose of sale.) t
O I,as'owner of the property,am exclusively contracting with licensed contractors td`con- Plumbing
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for .S.M.I.
such projects with a contractor(s)licensed pursuant to the Contractor's License Lew.)
Grading
O I am exempt under Sec. B.8 P.C.for this reason
Driveway Enc.
Date Owner Infrastructufe
WORKERS'COMPENSATION DECLARATION
I hereby affirm that 1 have�a`cert i ficate of consent to self-insure, or a certificate of
Worker's Compensation Insurance,or a certified^dopy thereof.(Sec.3800,Labor Code.)
Policy No,.- Company
CPCopy is filed with the city. O Certified copy is hereby furnished.
TOTAL 108.00
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of thg 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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
j Rear Setback from"R ea
CONSTRUCTION LENDING AGENCY Side Street Setback fro enter
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued.(Sec.3097,Civil Code.) Side Setback from Pro D LI
Lender's Name
Lender's Address `} t
This is a buildingFINAL DATE INSPE R
permit when properly filled out,signed and validated,and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
I agree to comply with all city and county ordinances and state laws relating to building ? ,
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes. Validated by:
Signature of applicant Date /
Mailing Address Validation: t /
City, State, Zip
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SO.FT.® $ UNITS
YARD SPKLR SYSTEM
2ND FL. SO.FT.
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO.FT.® POWER OUTLET ROOF DRAINS
CAR P. SO.FT.® DRAINAGE PIPING
WALL SO.FT.® DRINKING FOUNTAIN
SO FT ® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET
COMPRESSOR HP POLE,TEMIPERM LAVATORY
HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SO.FT.®c BATH TUB
SO.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®11/4 c SEWAGE DISPOSAL
SO.FT.GAR® 3/4c HOUSE SEWER
GAS PIPING
PERMIT FEE PERMIT FEE PERMIT FEE
DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST.FEE ELECT.FEE SMI FEE PLUMB.FEE
STRUCTURE PLUMBING ELECTRICAL HEATING&AIR COND. SOLAR
SETBACK GROUND PLUMBING UNDERGROUND A.C.UNIT COLL.AREA
SLAB GRADE ROUGH PLUMB. BONDING HEATING(ROUGH) STORAGE TANK
FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE
FOUND.REINF. /�� GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APPJEOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. cu.yd.
FRAMING FINAL INSP. $ plus x$ _$
REMARKS:
ROOFING
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL