RPL (0210-084)LICENSED CONTRACTOR DECLARATION t
I 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. w --4
License # Lic. Class Exp. Date
M 1707 0:53 111C � 12{'3 I /0_
DateSignature of Contractor ✓T14'f''
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 MMPT 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' compensationjprovisions of Section 3700 of the Labor
Code, j shall forthwith comply with those provisions.
Date:``+ Applicant x f x ✓ d ... '`
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.
i•
IMPORTANT Application is hereby made to the Director of Building and Safety g
for a permit subject to the conditions and restrictions set forth on his nr
application. .: 's
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 f
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)` : ��°� ---- Date
• a,s,
i
�.'., Y PERMIT N
"'-'BUILDING
BUILDING PERMIT_
� � 1�i131
DATE VALUATION LOT" TRACT
JOB SITE
ADDRESS
[AP
OWNER.
CONTRACTOR / DESIGNER / ENGINEER
130B arouatw
DIWOMD aPOOS AIM SPAS
7r0..*;;41_MOMO DR 1.10!'
7''7-700.E21 1TAM rJ.?I.f5'+ M�"!°ITZ;#
LA QUINTA CA. C922.5 st
PAL,iv'E IYE + 'r CA, 922:11
('�t�G12.00�5>;38�t ' rV�X158
USE OFPERMIT
XOOL.AYqOR 1.PIA
POOL,, SPA, 8BQ (AX -31 1995).ALA33.sL9SMA;RM2=SHALL HV
P00i.,,ANWQR.J1PA 4 GOG.ftU IX
Y'� L
}
+�., �! {•� � ysp q'� �ii+Rly/r�g:+ p�} ��nycg pyy��
.7:ry'L���d.?1�9A�1/� D Cw�S�f W"d� 'L.�R.��NSI„dAi7 �.•J.SI,i:CM
(y��qy (per
45,91M�0
•g•) q �+1; (;� [�+�•p {�y ,y
Pf., I i:1•itcy FF:? 101 a0,00*419318 M&30
CONSTRi;C'i ON Fff. 101-00.03-418-000 $3f3 'go
M19CRANIC<AL F&E -K101, 101.000-421-000 524.00
91,.7'F1.1S &L FXi? - ;POO.I.. 101,00,10.420-C3W W.00
Pi,tl MO RM -1- Pool., 101.000-419.000 ��i<tiil
a'iI LiL A`iC) 3 A JQ PL,/R CIMM
D �w
tnO2 ' .lig .5'K.I.MUT fid” 99 DM, NOW
CtV of�CE D,EP .
Ft
RECEIPT
DATE
BYE
DATE FIj1ALED I
-�
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE'
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air i
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final f — 7 —�3
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
FROM :J GRAHAM FAX NO. :760321-
-)VQU
Cl L "TTA
& SAFEW DEP�
JIL
BUJILDI -live
ROVED
7
CP
ff:�
Mffi
Oct. 07 2002 12:14PM P5
IIA1900 9FO, AT Ab" WITH STONE
CAP AND BOULDER SPILLWAY
'4mvitz-, LA
4 BAR5TOMIS 8,0M AT
/M=NL APO
SV<\
ALL %lWnCIAL
VKUTH DOlafeK Ell!
4H" ry
UMURCLJ.A EARA SUCTIOA
fti!Eve PC$. AUTOMATK-
F-0 X eA-PAMM
x 'x
is m
X-�
>
y"\
y
Nel
JANDY P-56
NOOK CONTROL
A
PANA15-
Iv
FAMILY
MASTER
BEDROOM
R
7�—JAL G (d� bA[�6�C�-'CITY OF LA aUINTA SUB -CONTRACTOR LIST I �Q
JOB AODREBS PERMIT NUMBER OWNEp 1 Cr' d J6�1.... BUILDER `
. Only persons appearing on this list or their employees are authorized to work
La
on this Job. Any changes to this list must be approved by the Buikeing Division prior to commencement of work. Fa wlli re
jAilt in spa of work and/or the voidance
;� of buildingpermit. For each applicable trade, all information re uasted below must be oo leted a licant. On File' Is not an act: able
response.
CL trarster state CoWso r'a We orwe N 1"j= clew Bwdeaaa
m
N
of
CD
N
m
N
N
Q
Trade 1 txaatflptbn
n
Company Name
Clasxdiostion .
le.p. A. a C40
Limse NuMber
Ias3iLul
bur. Date
Ixxlxalaxi
Cmdo Name
(e.g. State FuA CatCoea
POW NUmbn
Maine Vadal
Exp. Date
laxhxlxx)
Ueetne Number
Casal
Eap. Dale
Ixxlnhal
EAWKWORti IC -121
ltd c-
�-
'7 l
I.3o•03
N
50 1
tal-0�-
O g
COtiCIWITMOM
Y Un1u�i
G
•3h
arh-
fJ 5��tg 1
• 1•03
S o
►02
tnwewa Ical . .
STRUCT. 8ML 10-811
� �noN'� �d -�S
C -
ci D
2 3i� o
z G r_
----- -
3•
� i 6g
b
Hua
2-10
_
MASONRY IC -391 Mrd (L— C'z� 551• a a� 2 0
PLUNIIINIO (C•3e1--�
LATH. PLANO 10-061
C 3S
tJ
E�b� X15
' l'D
t 34
DRYWALL (C•91
MVAC IC -2(H
sMiRCAL IC•Tta
�1R15
ROCIFINO IC -91 •.
.
smEET METAL (C -al
FLOORING iC-15)
9LAZING IC -171
t ULATUM IC -'21
SEWAGG VW. (0.43)
PAINTING t0-331
CERAWC TLE 1Q ")
CAN11175 IC -01
MCINO IC -1b)
LANDSCAPING IC -271
C>K
DIK
0K
COL
o (C
C