RPL (0210-280)50140 Malaga Ct
0210-280
i
`LICENSED CONTRACTOR DECLARATION , .
I hereby affirrri.under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date Signature of Contractor~
.VA W
f OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, 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).
( ) 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.
Se(+) I have and will maintain workers' compensation" insurance, as required by
tion 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:.
Cartier OTAT.B rtt: wl) Policy No. 04610461*2
(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 those provisions.
Date: A 4 & Applicant 4!
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 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 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. 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 for inspect9n purposes.
Signature (Owner/Agent) Date f;°)
BUILDING PERMIT PERMITQp#
,' '..:::s A•s 'cxC tPa:SF1 ^• t34Y
DATE '7 VALUATION LOT r TRACT
JOB SITE
ADDRESS 50-140 MALAGA COU APN
A
OWNER CONTRACTOR/DESIGNER/EN INEER
77-564 COUNTRY CLUB 7. MVE S'CME ; 37 P.O.: OX 1791....
PAT1111 M=T CA 9..2211 LA QL.FWA : CA. 92,"1 3
USE OF PERMIT
POOLANVOR EVA
P00USPA.ALARM Ssrl'r,.4f:RRIERS Sc'`3.t'.1,;4.. D& IN PLACE AT :PRF_-PR°,e?„S7'iE..R ,
12 ' 15 ai;;` 6r.:?A7; i+ ? J ?• i' F ?t'":,C+ t •i 5, a ' 5 fi ' i. 'i ; .fl,
1000X, AND/CSR, VA.
u4000.00 Ls
FxrVjM) cdmr y 5oZam6 a01
MMIr FEE sWS1gyy
.ELAN tY"Dex Mt. V030
tti,'d7iJ;7`KUCTION FEE $1,5:2.00
MEMMl ,Fii,t .. POOLS 1011.00 IATI.0 00 MIN
ELPLICTWCAL ITZ, .. K01, 01 TP00-420-000- $45.00
RECEIPT
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DATE I BY I DATE
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$36 x.3'0
$0.00
IMM
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
Set Backs
Electric Bond
J
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
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temo. Use of Power
Final
Utility Notice
COMMENTS:
Cif
ok iw0
Srlt 7" _ Lic. # 61461 1'
W K I" Insured
Mike McIntyre
Owner
N SPECIALIST
i Quinta, CA 92253
-3585 • Fax: 76o360-343
. Art694
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