9905-367 (RPL)77385 Loma Vista
9905-367
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
c" retractors to construct the project,(Sec. ,7044, Business.
Code). _ .
() kam exempt under Section B&P.C. for this reason
PateSignature of Owner, t
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 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 persop-in,an.y manner so as to become subject to the
workers' compensation'laws of Calif orroa,`and'agree that-if-.I_should become
subject to the workers' compensation provisions,of Section 3700 of the Labor
Code shall forthwith comply with ttiose provisions.
Dai: Applicant
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, intere'.st_t 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 his
application. r
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 that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorizereft6e entatives of this City to enter upon
the above-mentioned property for. inspection purposes,
.54nature (Owner/Agent) ---rDate -- f
BUILDING PERMIT PERMIT9905-67
DATE &«271.1 "VALUATION $18,,400.00 LOT 31,32 TRACT 25237
JOB SITE
ADDRESS 77-385 LOMAVASTA
APN 631-820406
OWNER
CONTRACTOR / DESIGyNER / ENGINEER
ARM,
PCS ,BOX 1423
SAN'T'A. ROS.A CA 95402
c>- CB10
USE OF PERMIT
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POOL t1NRWOR. SPA - Io, ik O.Cta La
Ft, :!3if1RIA1lARY
I'LAN01ECk+,.FEE t0k-(1f,?t1-4_39,- 18
t"'f3:NSTRt11(-110NFR-F, IM -000-4.1£1.000 $fSrSEk)
A,ii4 t,'A;' l'«1 .ijTti • I'Ck: L 10.1-aW- l" I-000 1-24.00CLP.C11
E :A1, _ F -- K)0L 101-000-420-1 O W.u!)
VIAi&181t10 FIER -- lat:XX 101-000-4194JU SZ7.t? J
4i;., C CKSTR U M ON A,NI? N.I,.AN CH T_ CKK
$422.70
P LIMSS ME- AID r,EMS
50,00
MAY 2 7 19 99 Ti.) PMi Iff I+'N:,ES 1)1.3e, NOW
:SAL
$422.70
-I TY OF Lfill QUINTS.
a
RECEIPT
f
DATE }
i
BY/
DATE FINALED
INSPECTOR
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 .
0.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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond 0171
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
COMMENTS: j
4 f.5
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)