RPL (9603-139)78905 Lima St
9603-139
I hereby affirm under penalty -of. perjury that I am licensed:uncJer provisions of
Chapter 9 (commencing•with Section7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect. "
License # - Lia Class Exp. 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:
( ) 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).
( ) .1, as owner of the, property, am exclusively,contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). r
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. .`
( ) 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-isk;tsnued (%1, orkers' compensation insurance.cagne A tp�olicy no.' are'
Carrier " 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 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'otthe Labor
Code, l 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 $10000; in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a 'permit subject'.to the conditions and restrictions set',forth on- his
application. ('
1. Each person upon whose behalf this application is made .& each person at'
whose request and for whose benefit work is performed under or pursuantfo
any permit issued as a'result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La. Quinta„its •officers, agents and •employees:
2. Any permit issued as a result of this -application becomes null and -void if
work is not commenced within 180 days.from date of issuance of such
permit, or. cessation. of -work for 180 days will subject'permit to cancellation.
I certify that I fau,' read this application and state that the above information is
correct. I agree 10 comply with; all City, and State laws relating to the building.
construction /and. hereby authorize representatives of this City to enter upon
the abovesmentioned property for inspection purposes:
Signature (Owner/Agent) `' Date
PERMIT# CONTROL# "
BUILDING PERMIT,o„9
3034
DATE VALUATION LOT' TRACT •'
JOB SITE
APN
y •[ .�y
ADDRESS - %�-.QtiV�7ai.tYSt9 i
t _
OWNER
CO,.NTR-A..C.TOR/D.ESIGNER ENGINEER
-' .�1t {i;.llm• ..
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'CALIFORNIA y✓JLC a
�itSvAN
'79-9051XVI l
4191.0 K)ARDVvItLK.f1.A t
LA QU:tAI'�'.r1 . `� CA. 92253
PAUNI DRSE 01' I, CA. 99260
t 0 j nj 4U7911i30 C,BLO 2A55 .
USE OF PERMIT
Kli L AND/Ok SPS
la3:IOL AND .S' :VANE. V '
KNOL iiNDI RR SPA :L3
.Gg��gg.fAg:.►e:$,?►'i•'iiC.'i�W'e't'>.Sr'�,'�.r�S'�'.:a1�.,""d'nC3.i
•'•, , -8�e,rD'�ii$9. '
g ��.yy �pqq{p yy(�aa11
tla "Sl �.O.C�L�,I'.1,... ., ... •.
Ft, AN +MR!',CK Y,” k, :101.40A'9 -f3 11 $99.45
.T E7E !01-000-418,_'000 153.0v
!'ld�t:'l�1tpE�l.1"l,1 .,-'F:'a�C?i.. l(11:-'011O•�2tl��01?u $/t�;lC►
� �, ,�� t
PLII tN-10WO V00,i , ' :101-0 -09' 4*0 $27.00
<r
y
slut3-"t'd itL C:€Ji�'ti"!'gwrUT'iON AND PLAINT CHECK
$1418.415
"-pees .1.?u-PAW FEES
$0.00
TOTAL;1%,1ti1<ii.3';f FE&S DUE, NOVV
$348.45
RECEIPT
DATE
BY
DATE FINALEO
INSPECTOR
INSPECTION RECORD
OPE,'TION
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 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 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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Q—
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: