RPL (0006-400)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed I: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 i I Exp Date
721005 C-53 04/30/2(
Dated J�Signature of ContractorrA"''
OWNER -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).
() Lam 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 2XEMPT Policy No.
(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 becoe— bject to the
workers' compensation laws of California,.,fnd agree thatsif Ifshould become
subject to the workerscompensation royisions of..Section 3700 of the Labor
Cg6e, I shall. forthwith comply with thosro isio it
Date: 'j%ApplicantLAfl -tole
�r�---
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 the Director of Building and.Safety
for a permit subject to the conditions and restrictions set forth on his
application. s
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 above information is
correct. I agree to comply with all Gity, anAtate)aws relating to the building
construction, and hereby autho�e reVesentatives of this City to enter upon
t� a above-mentioned prope yfor ins ectioonn poses.
Signature (Owner/Age, t `"�--�' l5ate
X
BUILDING PERMIT PERMIT#
DATE VALUATION(}f�pgqC•6-��
,1 .1001.0 LOT TRACT
ADDRESS 49.,4M1dOI AffA, WA7y JOB SITE
APN
OWNER CONTRACTOR/DESIGNER/EN (NEER
1a1fA D.A"AROSSA VALZEY k'OOL & SPA
49.5401MSOWIA WAY 4741 C X PALM CANY014 DR. 0116
LAQDWA. Cep, 92253. PA.LU �R.INGS C`: AFS 3
9226
(760)778-3939 CBL # 2565
USE OF PERMIT
TOOL AWD/CJR 83PA
POOL & 3PA&BBQ( N51/t ) CDl<JLY- ALARMW BARRIERS SHALL HE IN
PJ..E C&AT .PRE PLAS` EP, 1WWSPEC"TIOW,POOL RQUIPMEWT WCU)SURE tS
NOT INCLUDED Y1:4 THIS PERMIT
POOL AND/OR SPA 25,001,00 LB
s
fi • �
X6I` WAT ..D COST OF COXRS'.i'4'JC`17OK
251000ko
PXRhUT FEE SUAWARY
PLAN CHECK FER
101-000439-318
$163.80
CONSTRUCTION FEE
101-000-418-000
$232.00
11 EC:i•L VW1CAL ff. ,Z •- POOL
3.01.000«421.000
$24,00
EuCTRIC:AL PE _• POOL
101-000-420-000
$43.00
PLUMBINO FF,n --FOOL
101-000.419.000
SAW
SUB- I OTAL CONS`CR UCT 014 AN -D PLAN ,;� .CIC $511..90
LF.,Sq PRE -PAID FM $0.00
'07fAL FKRTAIT EES DUE NOW 11 IN
RECEIPT DATEBfY/i A, I DATE FINALE i - U� INSPE- ,� /
INSPECTION RECORD
OPEPATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slat; 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
Partj Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas PipingI
—
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
— Ol/
Gas Piping
Gas Test
Appliances
Final
, �(-_ /z
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:
JUL-01-00,01:48 PM NHF CASTORENA 760772 5860 P.06
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