RPL (0101-159)53800 Avenida Martinez
0101-159
LICENSED CONTRACTOR DECLARATION
4,hereby affirm 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
15.14981
,/ate 4 +— Signature of Contractor '
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.
( ) I have and will maintain workers' compensation insurance, as required by
Section 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:
Carrier,, Policy No.
(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:.,. t e sr Applicant–
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his J
application.
1. Each person upon whose behalf this application is made & each persty
whose request and for whose benefit work.is performed under or pursuantio
.any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
'the above-mentioned property for inspection purposes.
r
Signature (Owner/Agent)) Date • /, '
BUILDING PERMIT PERMIT#
DATED VALUATION LOT 01 GJ_.h_C{ TRACT
JOB SITE
APN a'
ADDRESS.
i'.
OWNER
CONTRACTOR / DESIGNER / EN (NEER
00'i ONFIT, EMMIRT)1;t.". y...{,
COMM b`.:°ORMY7MION
Fr.,> BOX 369
'78•1.50 CAI UB TA1tiIM-0 SUITHW 30
LA, QrJ'TY',TA to %2.2_` 1
A QtM3'rA tin. 92253
r' 6f0>Xv4'AirXA (i'BUY` 2261
USE OF PERMIT
11100 .NVIVOR VA
POOL sSIrt ALL Q2h; lief PI ACE AT PUS P,$AVER
lid; Ta1 ; " )t?l .P .3tyd..T t 1t i i 3i'•1' F23CIMURF TO NOT INb:1AWRIT)13F'1'HIfi
lylm3t:4ti9t`R' .
PDOL A1*91 IDR SPA 6,400,00 Lr
fRc {t ff y yy ;;vvpyryry tt^^ ,, --cp,{ 6 `^ 1;, q, ,fi >Y•c/^gym ypy DFt
,L'n T rC.L77.6:'a iJC ) ti.+41U 9.fF Q 7JN4d.: NA.l.t y..SION
UN
$Y
MAN CHBICK RIP, 101 -000,439-310
CONSTRUCTION RY, 10..1 -t"00 -41t,'- 00 f4E,00
MHANICA.i. FFIE _ Pool,
["%Xxb7•kt N' Firm .r Pool, 101 -000-420-000
numm1^To 1'OOT, 101-;000-419,•000
ir)
_
N 16 2001
B" LA UU,,
InTAL Ct}MMUC:TIO D I-4AN fNM 41C
$229.65
IMSS PRE -PA, W FE
$0,00
TOTAL.,. F'KRW1' VEXS D NOW
.. .yu 4
$229165
RECEIPT
DATE # `
BY/y ,
DATE FINALED
INSPECTOR
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
Set Backs
Steel
Electric Bond
Footings
Main Drain
l
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Testi
_
Final
Gas Piping
x��-0
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PLUMBING APPROVALS
Gas Test
I �—
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
_
—
Gas Piping
- -`
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wining
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Tem{p. Use of Power
fe
FirO�
Utility Notice (Perm)
A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED - w -A
PLANS AND 10B CARD ARE NOT ON '
THE SITE FOR A SCHEDULED
INSPECTION.
NO EXCEPTIONS!
100'
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVEDi
FOR CONSTRUCTION
ATF I I, L /o r _ BY
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PROPOSRD RESIDENCE.
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MARTINEZ
53-800 AV9.MAR•rINRZ
LA. QUINTA.CA92253
CORONEL CONST.
P.O.HOX 369
LA.QUINTA.CA.92263
OFF.564-4804
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POOL 214'X IX W/I H.P,PUMP
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