RPL (0209-180)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under_ of -
Chapter 9 (commencing with Section 7000) of Division13 of the d
Professionals Code, and'my License is in full force and effect.. �—
License # Lic. Class
�te +��f'' Signature of Contractor s` r � ���`� - 16—
OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 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 '0' 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 arvwT Policy No.
i
(This section need not be completed if the permit valuation is for $100.00 or less).
(y) 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 agre& that if I should become
subject to the workers' compensation prrovislo sjof8ection 3700 of the Labor
Code, I shall forthwith comply with those rowslons.
Date: ` � 5 , 60 Applicant f
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. k
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 for1rispectionPpurposes.
Signature (Owner//Agen)) Date,91-2
PERMIT #
.�_ ��� :���DING PERMIT__ . ti � �
_- • ��c�..� Y
DATE I VALUATION LOT TRACT ;
:JOB SITE
APN
ADDRESS , 79-.512 S>M R OMVEY ST
r
OWNER >'
CONTRACTOR / DESIGNER / EN (NEER
DIAMOND POOLS ARD SPAS
1.0519 V AJ. L, Y 3PRM0 J I.AM.
77 n7Ory .rUNV MD LAKE SUM R
':taOLUCALA 01 E"A 04507
RA.t161DEST,'�i7 CIA 02211
a'J6Uj�.C3G�5��� �� 31�tiC
USE OF PERMIT
110011JAMIOR SPA
SRA, . ST'S A1i M ;�P.L.7�t[,igC�ysE �7.T
gTR;.�BE
(PO�yOLty,� gy�sIJU r�4/SVst�y3�AA.�2q.R.'iP+J�'14LS
•� q,.y q�y��j.
$".�9.F�+ PLaC Sd�l<�rdI 16�1SPE(t? k�dK .a'r���.�P7VtT.. I A T:�'CLON RF, E'd<+�.1 fflcujDt r: l .
VALUAT 1014 47,006,00 1A
1":b"�'Mi %TKD COST OF C0X6,*CkCJM10X
47,f)l7EXOD
1'1 Jll1 C✓HE0r, R 1®'1:4)90-439-3 16 S256.73
CM4511x'UCTION PEE 1011-(IQD-ti•18-000 $396. a9
%IW•li.dNICALFS--1160L 101-l00-4`2.1-000
.IYV "fRICAf..FEE—POOL ;02.000420-1:-00
P-L'u Maim) Fur, .... roofs 101 -clop -41 's', ctc)o
r' <
• 3 ' - xO`%t>L CClAiS`: RUMN A1. D Pt 11.R CWZX
`V141 J S
FOUL Pmwr Frus J)VE Now
SEP 2 5 2002
$74"T .7!1
CITY OF LA QUINTA
FINANCE DEPT.
14
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DATE INALEQ,
(��
INSPECTf��
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
'. Backs
Electric Bond
_Jtings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
p (J_ (j
Underground Plbg. Test .
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
_ —a
Waste Lines
Heater Final
Water Piping
Plumbing Final
,Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pocl Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
Utility Notice (Perm)
COMMENTS: