RPL (9905-204)77325 Loma Vista
9905-204
LICENSED CONTRACTOR DECLARATION,
I hereby affirm under penalty of perjury that I'am_ licensed under provisi.ong.,of
'6hapter.9 '(6ommencing with Section 7000) of Division 3 of the Business and
D
Professionals Code, and my License is in full forte and effect.
Lic Lic. Class_-_ # ..-Exp. b6td
6
Jo
01,131ii9i, .
A
ure of Contractor
Date. J; '2212.Signat'
0
OWNER -BUILDER DECLARATION
Nfli 74ARICALT.16z0424--OW
I 6by affirm under penalty of perjury that I am exempt from the Contractor's
--
License Law for the following reason: . . i I -
1, as owner of the property, or my employees with wages as'their/sble
Fell -- Pool,
compensation, will do the work, and the structure. isnot intended or offered for'
sale / - • -
S, c 044, Business & Professionals Code).
U
as owner of the property, am exclusively contracting with licensed
cohtractoes to construct, the project (Sec. 7044, Business & Profes ( sionals
•
J" IArn exempt under Section B&P.C. for this reason
Date . Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby.affirm undeie, pena . Ity of perjury one of the following declarations:
1 have and will maintain a certificate of consent to self -insure for worke'rs'
compensation, as provided for by Section 3700 of the'Labor Code, for the
performance of the Workefor which this permit is issued.
I have and willimaintain workers' compensation insurance, as required by
Section 3700 of the,'L613dr Code, the performance of .the work for which this
permit. is, issued. My workers' compensation insurance carrier & policy no. are:
Ccirner Policy No.
'66
(This section need not'66 completed if the permit valuation is for $100.00.or less).
that peryim'
ance of the Work for which this permit is issued,
. .
I hall not employ any person in any manner so as to become subject to the
rs ,
it,
workers' compensation, laws of California, and agree that if I should become
subject to the workers' compe*6ation. provisions of Section 3700 of.the'Labor
Code, I ghalil.f6rthwith com'ply'with those pr6yisions.
/Dafe:, -'Applicant,
Warni.ng:,-FailUre to secure Workers ' Compensation coverage is unlawful and
'
shall.subjebt 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
a. permi, subject to the conditions• and restrictions set forth on his
for,t b*
application.
11'.`Ea6h person •upon whose b6half'this application is made & each person at
whose request and for whose benefit work is, performed under or pursuant to
.k,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.
Any: permit issued as a result of this application becomes null and void if
I. work is not commenced within -180 days. frorn,date of issuance of. such
permit, or cessation of work for 180 days will:subject permit to cancellation.
cbrtify,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 bbilding
construction, and hereby authorize"rd'presentatives of this City to enter upon
th6. above-mentioned property for inspection purposes.
/*
[RE
Signature. Dated -//
_(Owner/Agent)
J
-- PERMIT *-
BUILDING PERMIT'.'
9905-204
ATE VALUATION LOT' "TRACT.,
A.
a
BSITE"'ZI APN
DDRESS
7-7-325 LONIA V(STA .63
WNER -
JOE & CYN11DI, 1'.."N11311111ESKEUT11
40,140TH ST
NEWPOW'r DEACH -.CA.'- 92601L
SE OF PERMIT
POOL AJK1)10k1S N%-
POOL&SPA ONLY
P001. XANIWOR SPA
CONTRACTOR/DESIGNER/ENGINEER
' 4
ROXRJLE CONSTMUCIRON
P.O.
LA QLumrA- CA 922,53
CRU IRI)
SUMOTAL OT011RUC AN XP- kv. T 'H ,CwK
USKS PRE-FIA(E)FEES
PERWIFFEWS DUE'NOVIr
T01"Al
MAY 1 8 1999
31 1 TY ®F LA Q U 111"MI I r"
CEIPT DATE # I BY
DATE FINALED JINSPECTOR
$193f*
$0.00.
CONMIUMON
MrWiTMEE SM&LARY
PLM. cock FF rs
3117: 00
CON -4'-0.1;I" VON FFT
Nfli 74ARICALT.16z0424--OW
Fell -- Pool,
Pool.,
11,011000-419-000
•
SUMOTAL OT011RUC AN XP- kv. T 'H ,CwK
USKS PRE-FIA(E)FEES
PERWIFFEWS DUE'NOVIr
T01"Al
MAY 1 8 1999
31 1 TY ®F LA Q U 111"MI I r"
CEIPT DATE # I BY
DATE FINALED JINSPECTOR
$193f*
$0.00.
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
to
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
ra
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fndures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: