RPL (0103-061)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
Date Signature of Contractor
`.
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).
O 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.
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.
h7 Al.`b.i .{:d.l'-WI AY SY EA'1�p+B"Y7.'Pi/'"ffi°
(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 3700Af the Labor
Code, t shalt forthwith comply with thos 1 provis ons.
Date: Applicant-
1;4
pplicant
1;4 11 t A
Warning: Failure to secure Workers' Compensation44coverage isunlawful 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 Saf&
for a permit subject to the conditions and restrictions set forth .on 44
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, &ishall, indemnify r
& hold harmless the City of La Quinta, its officers, agentgyand 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 f6rinspection purposes.
Signature (Owngr/Agent) -// Date
n•.c r
BUILDING PERMIT PERM T#
DATE VALUATION LOT �D4.'?I_tfy� TRACT
JOB SITE '
APN IZ
.ADDRESS
49-519 MONIANA WAY
OWNER
CONTRACTOR/DESIGNER/EN INFER
17 1"i I M '!?'!' 6
74 725JOM, DRIVE, #A
LA,, QUINTA.. Cid+,, 82.253
P,ALlw DEalwit CA 92260
(760)340.9000 M"t 5386
USE OF PERMIT
POOH:.. VAYORSPA
IN P1ACK T PRf-',PLAZ.r1;FR
POOL A14LVOR SPA 21,8000 uq
E611b"YED 4.`M OF CONSIM.M700
a �Yi3Qh?.t�J1
FRR-IM.T FEE SUMMARY
PLAN!+'EY��:p�e� 101-000-439-318
y�:r1Y�!}�pCK
C✓SPL9+T L6C7''L." A I N Fa?, 101-000-418-000 gA6J.:JM1i
't+ EC HANMAL FF, Z -- POOL I O!"'00.4,21 �000 $24.00
r.EC'9'RIC'Al. FE9, - POOL 101-000-42E1-Mq $4.5.00
isk.`liNK"a F.E11 - pp,0l,s 101-000-419-000
AR 12.2001
Ulm LA UUN,
Iii$=701'AL COMM"d:7COXION .AWD :FIX" 0MCK
I Two : AXriAMme's
X•
RECEIPT
DATEr.rBY
r' +
�F
DATE FINALED
INSPECTOR
90—
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireolace P.L.
Grills
Fireblace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Extortor Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
_
_
Footings
Bond Beam
Underground Plbg. Test
Final I i
PLUMBING APPROVALS
Waste Lines
Water Piping
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
D�
V'
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
O.K. for Finish Plaster
Pool Cover
Encapsulation
Gas Test
Appliances
Final
COMMENTS:
12 —3151-z
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FixtL res
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoker)etectors
Temp. Use of Power
Final
Utility Notice (Perm)
J