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RPL (0301-221)77470 Loma Vista 0301-221 ",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). ( )' 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 I 1 ` 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. ( ) 1 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 . WA`a')t?FUND , Policy No. 1640236 (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 of the Labor Code, I_ shall forthwith comply with thoserprovisions. Abate: .1�•r,e -121. Applicant— Warning: pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation,damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for .a permit subject<to, the conditions and restrictions set forth, on his application.. 1. Each person upon whose behalf this application is made & each person at, whose. request and ,forwhose benefit work is performed under or pursuant to any permit issued as a.result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2''Any:permit issued as a result of Ihis application becomes null and v Work is•not,commenced within 180 days from date of issuance of, permit, or cessation of work for 180 days will subject permit to cancella I certify that I have read this application and state that the above informati s correct. I agree to comply with all City, and State laws relating to the.; buil construction, and hereby authorize representatives `of this City to enter •u on the above-mentioned ve-mentioned propertyf r inspection pection purposes ' G a rf r1 `a sSignature (Owner/Agent),_.��• � • �f�r •'"`-�� �'"T'Date� M1 o PERMIT# BUI• j. rING PERMIT LD DATE r �' VALUATIONJ/f��IQI, LOT TRACT JOB SITE ADDRESS ��^*i,r�cQ.Y`Sr� V�1rr APN ` OWNER CONTRACTOR / DESIGNER / EN INEER ` JAY BADMI 1,A QY.k31 A CA 9223 ' i.,A• Q1 (760)360-7.648 OKA,, 7>5 � USE OF PERMIT POCYL•.rNDAM SPA POOL, S}ll�.ly,A��AyTrAt.�'+d�'1i?Ig��. IN f'�..A.t:.�''.' , AL�.'lyetiT14114VMB,a��eR. R.t�l! RS,r$,'tdpAgt.�`kr:+��pi� yl�.q;�t"a:�'e'WJvpPy�Fyrp'' � . .ti.D S„ &I'LA,0tER llf`70S`YJ"Si�I.+ IGH, �!j!1�A3'�JI>v.0 F1401t.N�iISURK, NOT INCLUDED. • ry�,p py�'[�[Y y �j y� vy,�/��n �p �V�1y� /� co aLokw2��:??�� w con 4l�cr� co U' .ai•,4,d.8-•i.!.7a�E �d7 /,,� �(yry �`�p� 1v�:�:1�'4Yla' ID MAN C"HR111C FEE l Cl3 �t'1�"3Ci�� �°� � �i �2�a4,A•� CUNSTRUC e iOrN ME 10 8-000 14.54) ZC H.%1 -u A,L rn -- PoOL 101 -WO -421-000 $24,00 EL:Nd UR1t: AL --POOL 101 -000-420-000 $4100 PLUMBING FER POOL 101,,000-41.5-000 $174; M ryryR P NppD REN jjfryy p� i Y31,fsG;1 Ti '�' ►7t� 's.9a ri. Now 'S779 S fLATy QUINTA r re r RECF.qK{► E'[ j. 7 3Y'M D FI /Jr INSPEPTOY r . V 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 APMOVALS Steel POOLS - SPAS - � Set Backs Electric Bond LL C 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 Sewer Connection Pool Cover Encapsulation _ Gas Piping Gas Test Appliances . Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring IL.ow Voltage Wiring .jixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: - ' • R G l F 1 n "'i. J '"Sj L+..:<, ,''� P,g .-�_ .p 'em's. ...,r=`"""• •�, .. � � r .n, y i Cpl ! 8 J J i , lvo I r r � % , C .. 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