RPL (0009-235)53020 Avenida Madero
0009-235
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I.am'licensed under provisions'of .
H Chapter 9 (commencing.with Section 7000) of Division 3 of. the Business and
WFrofe'ssionals C&dd,'-ancl-'rriyr License is in full force and effect. ` "•
O License # J Exp:
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C) Z,I 'Date 41%, Signature of. Contractor
Uo {;:' OWNER -BUILDER DECLARATION
.
W'W I hereby affirm under penalty of perjury .that'l,am exempt from the Contractor's
~ a' License Law for the following reason: i
Z ( ) 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 offe ecl,for
sale (Sec. 7044, Business &,Professionals Code).
I, as owner of the property,,am exclusively;/contracting. with lice
contractors to construct -the project (Sec. 7044; Business & Professionals
s , Code).
'LO O .I'am exempt under Section B&P.C. for this reason
s N Date Signature of Owner .
O, '.
V °Q WORKER'S COMPENSATION DECLARATION ,••'
' o I hereby affirm under penalty' of perjury one of the following declarations:
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FZ O (.•) I have and will maintain a certificate of consent to self -insure for workers'
-X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J 'J. performance of the work•for which this permit is issued.
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Q U. O I have and will maintain workers' compensation , insurance, as required by
Q Section 3700 of the'.Labor Code, for the performance of the.work for which this
H _ permit is issued. Myworkers' compensation insurance carrier & policy no. are:
• z Carrier Policy No.'.
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Q (This section need. not be* completed if the permit valuation is for $100.00 ortess)>
(.) 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, andagree that if I should become
Subject to the'workers' compensatio provisions of Se t'IRo• n 3700 of the Labor
f. Code, I s a forthwith comply wit )'th Ose drovis'rons ' 0 .`
Date `a.. r' ✓ Applicants
Warning:•FAilure to secure Workers' Compensat n c verage 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, .'
IMPORTANTx4plication is hereby made to the Director of Building and Safety
for a -permit. subtect` to the conditions and restrictions set ,forth on his
application:
°'Each person upon whose behalf this application is made'& each person at
- 1 whose request and for whose benefit work is performedunder 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: r agree to comply with all City, and State laws relating to the building _t
construction, and hereby' authorize represen ati es of this City to enter' upon
the above-mentioned'propert' for i spec io u oses:.
Signature"(Owner/Agent) ✓'' Date
BUILDING PERMIT PERMIT _
DATE, VALUATION ', -, y _LOT' ° TRACT'b. '
JOB SITE-,-'
ADDRESS t
APN i 3.
OWNER
CONTRACTOR/ DESIGNER /,EN INEER '{
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PACIF17C AOM U,
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USE OF PERMIT :r
1100LAWINORSPA.
P001,4. 4. °sPA ONMA11 ARlJ9M,Gt.t2 dERS SHALL RI`? I'M 1131AClp:r T P' -M, `
LA x B !'P36 a 'r"ta i. 4 91.1it 1t1 ' 9,I Al 91,141GLOSURE IS NOT rNC9Lt D9D
DIN T1111S VZ011T
POOL ANVOR SPA HORN Lo
'A VY ONSTRU(MOTIF
1;.'.HE0F. M, 1 ti 1-ftCYf)•w339w3 k S1 5111.frt0
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+C"O,'fu`'S, "; 3fa'•'i`ii: 3 ']'rff<T4: 1011.-QCt`1-43 r Tt'J61. t ti:,OtB
MECHANICAL FER . POOL 101 -000-421 -OW $ 4,t14t
tib P :Y`I itr. .ea 1'f't .d- PK«ol ; . T(D1•CPQ(1-1f 45-Qf3fl $4 ,fiti
. PIdaxWtWO FEE, ..PO01, 101.000.419.000. $27,00
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'V. 03.90
NOW
OCT. 0 4 2000
Kim
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
s 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
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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