RPL (0307-267)54725 Avenida Madero
0307-267
LICENSED CONTRACTOR DECLARATION
| ` y |a pro isions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Bi!siness and
CD Y
04 LU Professionals Code, and my License is in full force and effect.
r, License # Lic. Class Exp. Date `
LntD
c
rDate Signature Of Cont:actor'
pc C) '
msR'BU| R L R T'
ou 'ON
W UJ |here -by affirm under penalty mperjury that |amexempt from the Contractor's
F- co License Law for the following- reason:
z ( ) |, as owner of the property, or my ompmyoao with wages as their ool,e
compensation, will do the work, and the structure is not intended moffered for.
sale (soo.7o44.Business mProfessionals Couo).
( ) |, as owner -of the property, am.mxclusively contracting with licensed
contractors to construct the project (Seo 7044 suain000 & Professionals
Code).
(> |amexempt undo r Soonon_______ ouPC for this reaaunLO
__ ___ _
C\1 Date Signature of Owner '
cn
< . WORKER'S COMPENSATION DECLARATION
| xoneuy om,m under penalty o, perjury one of the.following declarations:«n ()|hmmonUvwnm moinanom oomv/conoent t self-insure for workers'
X LUu- cnmponooxion, as provided for by Section 3700 of, the Labor Code, for mo
[} mmmfor `
co _J have and will maintain workers' compensation insurance, asrequired lb
d () Gor6fibn 3700 of the Labor Code, for the performance of the work for which this
u'CY) permit is isououcompensation insurance vomo o. are:
zc Carrier C 0
3 Y0 NYl Policy
oyNo '61 -% a
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< (This section need not be completed nthe permit valuation is for $1OO.00mless).
( ) | certify that inthe performance ofthe work for which this permit ioissued,
| shall not employ any person inany manner oo as to become subject tothe
workers' compensation |a*x o, California, andagree that i, | should become
subject tothe workers' vomponxao i i f Section uroomthe Labor
Code, I shall forthwith comply with t dse provision's
Warning: Failure to secure Workers' Compensatibn coverage is unlawful and
ihall subject an employer to criminal penalties and civil fines up to $100,000, in
addition tothe cost mcompensation, damages auprovided for in -Section n7o6
oxthe Labor Code, interest and attorney's fees.
IMPORTANT Application iohereby made tothe Director mbuilding andGmety
,o, a permit subject to the conditions and restrictions set forth on mv.~
application. '
1. m up ~ o m each person ~~ whoseand for
any t issued as a result of this applicaton agrees to, & shall, indemnify.!'.'
& h=rmless the City - Of La Quinta, its officers, agents and employees
u. Any!pannit ioauau ay.a iresvumthis application uovvmaa nun and void if
nm,k is not commenced within 180 doxu from uma of issuance of such
permit, o,cessation of work for 1uodays will subject permit to cancellation.
d certify that I have read this application and state that the above information is '
° correct. | agree mcomply with all City, and State laws m|axingtomo building
construction, 4 huy aulhoriie representatives, this Qty toenter upon
"="""v"`'="'"''"" property for inspection tirposes.
|
Signature oam—~ - —
,-iJUILDING PERMIT
0.00 LOT TRACT
DATE VALUATION tl 70f
JOB SITE
APN
OWNER
CONTRACTOR DESIGNER ENEINEER
54 -742.5ANUDIMA NAAL%1KRC).
86-1t, WEN 1,54
USE OF PERMIT
1_1001, AN 1X01 R BPA
MACHARICALIKE POOL, 1101 _000-421 -000
PLUMBNOYEF POOL
393
JUL 2 2003
CITY OF aINTA
1) AT Ej,"'
13Y
DATEFINAUED
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 APPROVALS
Steel
POOLS - SPAS
3
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric6r
Underground Plbg. Test
=
Final
PLUMBING APPROVALS
Gas Piping
Gas Test
Electric Final
—
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Paris
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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