RPL (0402-034)53125 Avenida Martinez
0402-034
LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licynsed under provisions of
F— 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
I --d Lo
' W
oZ r- Date Signature of Contractor
(D 0
J U 0 OWNER -BUILDER DECLARATION
WWW I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) 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,rBiisiness &` Professionals
Code).
Cl) () I am exempt under Section , B&P.C. for this reason
O N Date - / !a u Signature of Owner jO/
4. ...rw.rv,r...
CL Q WORKER'S COMPENSATION DECLARATION
p W I hereby affirm under penalty of perjury one of the following declarations:
U-) F, O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q() ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
fl F— permit is issued. My workers' compensation insurance carrier & policy no. are:
-.I- Z Carrier Policy No.
W 5
JTM (This. section need not be completed if the permit. valuation is for $100.00 or less).
( )41 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: .%• ' ' 4f 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.l 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.
;,-ISignature (Owner/Agent• }t% Date
BUILDING PERMIT PERMIT#
DATE r - VALUATION LOT 0402-ON4 TRACT
6 BK 208 h
JOB SITE,
APN
ADDRESS 53-1!i}VERMA.X'V-0w6.INU
774-061-018
OWNER
CONTRACTOR / DESIGNER EN (NEER
`THRITR&M-11
77-480.L0*N%V1'rA
LA QiM:rrA C.A., 922M.
. CZ1.1
USE OF PERMIT
POOL t8MYOR SP1.
PCt IJSPAi ALAIN, S/i#Ali'. UMRS StiA't_.1, BE IN PLACE AT PRE- PLASTER
)A#BPt )'1c t5, f QUiP1r4k:1tiST 1GP i 1 1CfRE NOT )NC:l.tiDED
POOL KHDIOR SRA x3°
ar .+gISTE.Y,:.s7..7.E COST0. '43.od7FIR i. 7,AiJ.cE
Z✓ YFV a{.+SJ
yay yyq Y y' y, ■ *x
CON TRUt;'1ION:i?Fly 101-000-418-000 $1.17.00
MWWNICA 1DT.9..POOL 101-000.421-000 $24.00
P'd.1:t,:'% RIC.It L ME -- POOL 101 -000-420-000 $43.00
Pl,tifM131NO V'R, __ POOL 101-000-419-000 $27.00
D -
FEB 0 6 2004
CITY OF LA QUINTA
FINANCE DEPT.
4 UB -1`O AT COOffPRUCT109 ARD PLU C.' 1
$289.15
T. Z ME -PAID FM
$0.00
TOTAL 111YINKrIl I t,'s :0UE Now
$289.f1
, - 7
'RECEIPT
DATE ? % 9
.- (a G
BY
DA NALE
a
INSPECTO
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
POOLS - SPAS
BLOCKWALL APPROVALS
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 L/ v
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
i
Final
Utility Notice (Perm)
AVEmi
MY OF LA. QUINTA SUB-CONTI%CTDR
sulw
.IOB. 01tES dMy pmom appmlin0 on tNs list or dWr s"Wyom are euthoduci to work
IMS few on tNa iob. Mat cetisrsoas to this 60renatt be approved•bY the 8ailOM ulvwon to conmsowmft nt of work. Fs ecus to aartroh vriii rs U1_ slttapWPc of worn andlor the valQ
al but ' nut. far each abN . d infOrtnsdot► spa DWI mu 'aa eom
Ca Y Nwln Oboftss. t+N.e.. WAd . Era. Our
{aa. A. . Oil til (rih.M1
••. +• •,••
a s1.10 /Yud
t'r hc t+17-7:7
•
Eq. osa
79;449
t1..nn MrMmm
b
oanollErt oaa
. s at-
atAs
aTla,ta. sm ccan
PoaA 6usnRR 41 1117A3
u!
WOO
vr"E
no oa
-
MASOM 1111-M
! a
Ku ll+a te•sa
RO8EiRT uSo+ es •
C3—.0 3 7q
b l
Z.21 OZ&020711
S•1S'dq
t lcrt retlwsl
•M ao ¢
C-5.3
rnMflI .sa
Go-
tSl •C3S `
AA
- -- -
acK tc- m
Sc
000tetw ren
a ' `•
:Heart RAL a+>,
R04MIa Ic-9N
Q (O•tTi
tMa1M 110N {D$i
110VAN OW. MAO
f'A/ITMI01t:An
cam" "
19010 I&M
u xwc,atw tc
C —,C' W l
G 8 Zb
• b
- o S 30
' 41'
0
PROPERTY UNECKVMLL300
. w• ':• ; • „f ;` ' ° NEW S H{GH •_ .•
Ell
8,
' • it •'•,.' :• '* 'L. •. ; } 'i ' -100d
yr
ROLL -UP GARAGE DOOR
r' i 7••• S.• a ` •! :y Imo•' :' •'•'.v'•'i'
Ila
Jm-
' s. i . `' ti:: •.:• +` •ice ' \ ,.~
Q
y
_a
m c_
7.1
GETC
07
r 0) C,05
• '
c.0
z c