9906-014 (RPL)LICENSED CONTRACTOR DECLARATION
^ | hereby affirm under penalty ofperjury that |amlicensed under provisions of
Chapter 9 (commencing
'Professionals. Code, and my License is in full force and effect.
a /te
Signature of Contracto/
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I ahrI exempt from the Contractor's
License Law for the following reason:
( ) |, as owner ofthe property, mn9employees with wages aoma�'oole
compensation, will uothe work, and the structure �nmin�ndodo,oneeUfor
aa�(Soo.7O44.Bvoin*ou8'pm�oaiuna|»ovuo). `
( .) |, as owner of the property, am exclusively contracting with licensed
uontmomm to construct the project (Seo. 7044. Business & Professionals
Code).
( ) | am exempt under Section omPChothis o maoon .
Date Signature of, Owner
WORKER'S COMPENSATION DECLARATION T
I -hereby affirm under penalty of perjury one of the folldwing declarations.
I have and will maintain a certificate of consent to self -insure for workers'
6ompensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this'p6rmit is. issued.
lhaveandwill maintain workers`�omp�nsati�n insurance, as required by
Section 3700 of the L�bor Code, for the perf6rmince of the work for which this
permit is issued. My workers' compensation -ins6rance carrier & policy no..are;
(This section need not be completed if the permit valuation is for $100.00 or less).
()/ certify that'in the performance of the wbrk for which thi's 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'p rovi sions of Section 3700 of the Labor
C4e, I shall forthwith comply with those.oFovisions�,�
Warning: Failure to secure Workers' 6ompensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensati ' on, 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 �nd restrictions set forth on his
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 6greeszto, & 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 off , 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 i construction, and hereby authorize representaitives of thi� City to enter.uponthe above-mentioned property for inspection purposes.,/�ignature (Owner/Agent).. Date
correct. I agree to comply with all City, I and, State laws relating to th -
BUILDING PERMIT
DATE "W(J41.-I" VALUATION $33.$70,4�0 LOT TRACT
JOB SITE
ADDRESS
APIN
OWNER
CONTRACTOR DESIGNER ENGINEER
7_301 I OWNTRY CLUB DR., SUM- F4
I.;A:Q01NTA CA 92253
TALMIA' , SE 11T CA 92260 -
Q,60)1465-40,12 Clilr',# 1.044
USE OF PERMIT
POOL MFW0R SPA
VERAUT ME SUMMARY
YaTAUPERNUr MES OU E' NOW
SQ8.33
RECEIPT
JDATE
BY
DATE FIN . ALED
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
Gas Piping
Gas Test
Appliances
Final
FinalI
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: