RPL (9706-017)79705 Mandarina
9706-017
LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
O M License # Lic. Class Exp. Date
LID
LLl C53
cc
l 1
ZO r Date ) Signature of Contractor
~ — OWNER -BUILDER DECLARATION
LU LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)
Q WORKER'S COMPENSATION DECLARATION
O2 Z I hereby affirm under penalty of perjury one of the following` declarations:
r 1-2 O () 1 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 Q performance of the work for which this permit is issued.
m Q U ( ) 1 have and will maintain workers' compensation insurance, as required by
Q C) Q Section 3700 of the Labor; Code, for the performance of the work for which this
d v Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
°Co O VAULA IIW(.' SWA 12
J
(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.Ao 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=mply with those provisions.
Date: r ' / 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 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 inspection purposes.
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT# CONTROL#
706-017 5269
DATE 6/4/97 VALUATION S 15144m) LOT TRACT
JOB SITE
ADDRESS 79-705 MtiCYDARINA
APN
`r
OWNER
CONTRACTOR / DESIGNER / ENGINEER..I
DOYLE
BALIJ(fit 't i,1t.S , SPAS
79-705 MANDAWNA
74-"72V3NI DRIVE, #A
I QU1NTA CA. 02253
PALM DUSUMT CA (420
(760} i=la.VOt)t) C[lt,# 4367
USE OF PERMIT
P001,
IkAA, RNLI SIVA C ft.l
1' 1i.1)A't'iC fJ ):i,(l omits I..>
ISSTILMATED COST Of C.'QNS'IRUC-tION
1:.000.00
11VRX11T FCC Sf.{MiliARY 0.
461111 fNia
PLAN (141iOK Vtif? 101,000-430-118 SPIN X)
i'(INS7'12t)C"110N rt3's 101.000-41 R-0C)f)
NfiiC`t"NIC:AI.I ", --I'C1UL tot-O()0--132IditX) S t.Ot3
1.11CTRWAL YE,— 11001, iCfl-fit6(i I2Ci-Cri1ti 15.Ck1
F43(&11itW1'Hill' --1a+. 1. RUi-(Kit)-+919-(iflO xd7fu►
1`
rn
® C"
f •
LC.
f
C Z
SI_ttVMWAL 0 )NN71RUCTION ANI) PT AN C'1MC'K
RM310
LESS PKE''TA1D FEIi6*
$0.00. ,
T0,117A#, !'1 RIN11''P FI<;RS I fir NOW
'
S.%3.30
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Aw
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
-
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
72-2-271
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
Wily Notice (Perm)
COMMENTS: