RPL (0209-179)LICENSED CONTRACTOR DECLARATION
•1 hereby affirm under penalty of perjury that I am licensed.under provislo s,
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect. - 4
License # Lic ,Class Exp. Date
Date4-` "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). ,
O 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. _1 .
( ) 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 E?SL"i:i4T?'3 Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
Q 1 certify that in the performance of the work for which this permit is issued,
I s%ll 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 proviisions of action 3700 of the Labor
Code, I shall.forthwith comply withrthose.prov,isions.
Dates .3 e' 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;hisi
application. R.
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 for inspection purposes. i
Sif'nature (Owner/Agentl--1 -f-i '1 '1' Date
Imp
PERMIT = PERMIT
JJBUILDING
DATE �• VALUATION �e4 LOT i ..TRACT
tl
J OB SITE
ADDRESS 795 1KWAUNWOR DRIVE F.Aff
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OWNER
CONTRACTOR / DESIGNER / EN INEER
3oRTmCC' klawlY
JaifiMa.3ND POOLS AND 9RAS
ShCAM E . iii ' ('Jk 95918'
PP+LM:LlE'Wr CA. 92211
(°Suf 315£ ,
USE OF PERMIT
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PLA14 CI€ECC.. FTSE 101.000-4 9.318
CO3 IST:F2,4SCTION FEE 101-00a-4. 113 -ion 5!3
NIECHANIM,'L FEF. =- POOL 1491-000.411.000 $74.09
McLEX-3 UCAl:MZ- P001,J'3-0007�'`�2t3400 $45,00
k'I.,Ul41rBINO F -.. POOL + .101'-000.419.000 vznp
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PRE -PAID � `;
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5 2002
LA QUINTA
DEPT.
RECEIPT
DATE /„
DATE FINALED
INSPECT
76
`1N
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. 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
Footings
Electric Bond
Main Drain Q•
Bond Beam
Approval to Cover
Equipment Location
_
Underground Electric
_
Final
PLUMBING APPROVALS
Underground Plbg. Test
Gas Piping �0 _
Gas Test
Electric Final
Waste Lines
_
Heater Final
Water Piping
_
Plumbing Final -7
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fudures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)