RPL (0403-245)49535 Loren Ct
0403-245
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with. Section -70,00) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class a Exp. Date
06128 C53 PIC C-8 ori loe
q
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 . f . .
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). . . - I I I
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.
-.1, have and will maintain workers' compensation insurance, as required by
-Z
"I.SecVtion 3700 of the Labor Code, for the performance of the work for which this
Permit is, issufd'W wofkers'compensation insurance 9%gi%r & policy no are:
No.
Carrier i f-,
_(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,
1: shall not employ any person in any manner so as to become sub ' iect to the
workers' compensation laws of California, and agree that if Ishould become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I 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 $100,000, in
addition'to the cost of compensation, damages as provided for in Section 3706
of the Labor'Qode, 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 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.
I 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 cancellatio
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 authorize, representatives of this City to enter upon
the above-mentioned property fo'rinspection purposes.
Signature (Owner/Agent) IWI/)//j dr Date 1 1
-:Z7 ,7 57
PERMIT#
WILDING PERMIT 0403 AS
DATE VALUATION 41
VAL LOT TRACT—,
JOB
APN SITE ;r' 40 W.'Q-1,6k& barl-,RT
ADDRESS
OWNER CONTRACTOR I DESIGNER ENGINEER
ITIANS VIRM46usszia Jim c CKLWORNIA POOLS &SP&Sci nii"71VIAN c'O., ZP.
9968 11M.R111 S' ME 102 86.100 AVIMM,5A
CA 92111. COACIIELLA CA 92236
cul owm"_'
USE OF PERMIT
Xml, ARD101" SPA
07-1 A 11%1V -_- A I A WS4$1,10 A 11 eOf V 4ALL 04 4'-! n wrenP461QR
TO PREPLASTER DI'SPECTION. POOL EQUYPMORT 8'14MOSURB 14-0-T
r1RCLUDED M PERMIT.
POOL A11,1DIOR SPA 11000100 LS
SM
r,5-ITMAW-D COST OF CON, JU110n
VITA91'PiVY 90MVIARY
'PL&NI.t
C."Mr. 1170, 103.000-439-318 S
C014STRUCTION FEE 101-000-418-000
MECHANICAL FEE 101.000 -421 -OPO
MECHANICAL PEE --, POOL 101-000-421-000
BLECTRICAL FEE -- P001; 1.01 -000 -420 -WO $4.1
PLUMBINQ ri z .. Pool, 101-000-419-000 r
,,,,,,6 7.000,00
7,40
BUTI-IroVd, COKKRUC1101T AND PLAKI (TMCK
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.MAR 24 004
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QUINTA
FF I H AN C:E:D IE P T .
RECEIPT I DATE BY IDA 1NALED
Z93.00
ISPECOU.L,
BUTI-IroVd, COKKRUC1101T AND PLAKI (TMCK
_rWrAT
MUM M.9 -PAM Ms
1111ERDIff r YKES OXIT 117011V
.MAR 24 004
n CIF—OF—LUA-01 —1191-11. _J
QUINTA
FF I H AN C:E:D IE P T .
RECEIPT I DATE BY IDA 1NALED
Z93.00
ISPECOU.L,
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
Insidation
Vents
Fireplace P.L.
Grills
Fi eplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: