RPL (0106-323)52370 Avenida Madero
0106-323
'< ENSED CONTRACTOR DECLARATION
I hereby€ ffir.,t1 d%e
g alty, of perjury that I am licensed under provisions of '
Chapter 9 (cowith Section 7000) of Division 3 of 'the Business and
r oslonals yLicense is in full force and effect. r
9„
License# f;. f Lia Class 'r Exp. Date
,
n 7•- '3
Date"%. Signature of Contractor
r
p OWNER -BUILDER DECLARATION ° t9
I hereby affirm under penalty of perjury that --I am exempt from the Contt actor's
License Law for the following reason:
4 jn .
O l,.as'owner of the property, or my employees with wagesa t ieir sole ,.
'compensation, will do the work, and the structure is not intendedr6r offered for '
sale (Sec. 7044, Business & Professionals Code). /01
( ) 1,,-as'owner of the property',' am exclusively contracting with licensed
conteactors'to construct the project (Sec. 7044; Business & Professionals
Code). i
` O I am exempt under Section B&P.C. for this reason
.• , Date Signature of Owner
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L WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following -declarations:
C -
: ,..; O I have 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,
N 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
wit 1ho
.s oy.i.syion
eDate'Applicant_
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Warning: Failure to secure Workers' Cbmperisation covAage is unlawfu)rand:...
shall subject an employer to criminalpenalties and civil fines up to $100,000, in
`.addition to the cast of compensation, damages as provided for in'de'ction 3706
t of the Labor Code, interest and attorney's fees.11
.' IMPORTANT Application is her 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.
2. Any permit issued as a result of this application•bikomes 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.
1 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 fornspectioplpurposes.
` S g ature (Owner/Agent)'`
BUILDING PERMIT PERMIT# .
DATE VALUATION LOT TRACT;,,' ,
JOB SITE ;.
ADDRESS .
APN
o!/
;' 5U-310OrArDA tADIR O
7`73 ` Z-
OWNERr 1
CONTRACTOR/DESIGNER/EN (NEER
r, .
(-%11r.Ay MYa"Fa
Ltt4LLDFa, Y2WURM),INC. .
t t; BOX 450 't ,.'
.51-3 0AMpADERMUDASaPUx `. Zy.IRMI
;-KQMWA CA. '92253
1AQUUNTA. C'P. 9225.3
k
01510064-18601 ' mix 055
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USE OF PERMIT
POC& ab/tai, slv,
*int + ONLY, PERMIT ITORSNO k ,11ILCUOV, BLOCK WALL_ firOOL.A.LA)WS, ` +
R:EQ€;{,.F"LAD TO BE I?.iR"11 RD PRIOR TO Pit&FLAZ`i'ER 1NOMMON'
POOL ANWP, R SPA Qpoup La
MST OF C.<t3 Fsw.[x TTE,'°,i .4J3V•/
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PLAN CH WK YES, 10)-.000.435^318 . - tS 05
C011slIP;(I 11TION RIE 101.000.418-000 $1117"00
ZrIF.L14ANICAL FIR -4 POOL ` 101.02-4 21-066
°j &t:d .'TRICAL1+4? a POOI. Z?.C-C143ta $Q5.D0
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CjTY 0;E [-A Q0lNTAA---__
EINANC`E 0Epf i
SUN-WrAL CONS dRUC'ixOk+t'MY3 +GAN -0 t ' < •
$289.05
1. x39 FRP,-PA1DPF.W
$0100
RECEIPT
DATE
BY _
DATE FINALED
INS PECTOR
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INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
f BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
firms & Footings
Ducts
b Grade .J ,,'
Return Air
Combustion Air
Exhaust Fans
O:K.to Wrap,'
F.A.U.
Framing
Compressor
Insulation ,
Vents
Fi epiace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Footings
Steel
Electric Bond p,Of
Main Drain (
Bond Beam
Approval to Cover
Equipment Location
Underground Electric J• 0_1
• Underground Pibg. Test D
Final
Gas Piping
PLUMBING APPROVALS
Gas Test c
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 y! /o " „ T_
Gas Piping
Gas Test .
Appliances
'
Final
COMMENTS:
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)