RPL (0004-218)i vi= iSED CONTRACTOR DECLARATION' ,
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I.L.Chapter'9 (commencing wltli Section `7000),6f Division 3 of the Business and
rq W Professionals Code, and my License is in full force and effect..
OM License # t Lic. Class Exp. Date
aLO,
45 ,6 "�J12 C53 1:0�33,�2C
�o Z �. 'iDateG -�• aSignatur of Contractor '` 7 �s
J UCD
i� ,I` ~ v ; OWNER BUILDER DECLARATION'
' W W I hereby affirm under penalty of perjury that'l am exempt from the Contractor's
~ a License Law for the following reason:
Z '( ) 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).
( ) 3 I, as owner of the property,am exclusively contracting withIicensed
contractors to construct the project (Sec. 7044, Business & 'Professionals
- .. -
cO O l'am exempt under Section B&P.C. for this reason
O N Date Signaturef of Owner
rn . ;-
U Q WORKER'S COMPENSATION DECLARATION
lO Q'�, I ;hereby affirm under penalty of'perjury one of the following declarations:
_. O () 1 have and will maintain a certificate of consent to self -insure for workers'
'''•Xw;,LL compensation, as provided for by Section 3700 of the Labor Code, for the -
J'Q . performance of the work for,which this permit is issued.
00 Q C) (') I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of.the Labor Code, for the performance of the work for which this
C Z permit is issued. My workers' compensation insurance carrier & policy.no. are:
Carrier Policy No.
4'. oo 5 SUM FUND ik6-0If-060dI6�-p®
OQ (This section need not be completed if the permit valuation is for $100.00 or less).
J O 1 -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 agreerthat if I should become
subject to th wor ers' compensation provisions of ection 3700 of the Labor
Code, I ha f rtb ppomply with those pro f6s
Date: %a 4pplicwf- �-
Warning: Failure to secure Workers' Compensation coverage is unlawful and
- shall subject anfemployer to criminal penalties and civil fines up to $100,000, in
addition to the dost 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. ��
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 isnot commenced within L180 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, arid hereby authorize representatives of this City to enter upon
the'above-mentioned property for inspection puposes
e400
Signature, (Owner/Agent)`<% Date,Tw
• � ` �' BUILDING PERMIT • � - ..PERMIT# ', '
DATE "'�"��
VALUATION LOT TRACT ,
)P6
$1410
JOB SITE )
APN
ADDRESS. •49-6tF><i �%.. SIONDRIVY.- VMW.4
{ ro
OWNER q
CONTRACTOR / DESIGNER / EN INEER
.1
. t
t
S T
TD DESM I EVELOP1 iTNT .
CALS3v'0.1 NIA POOU & SPAS
PQ 'RCi; a 1'71, 6 'r'
74-7 25 JON, DRYVR, 0A
L QUINTA CA 92259
PALM. DESERT CA 92260
(760)340-9000 -0-BLO 355
USE OF PERMIT
POOL AND/OR krPA
,
POOL ett. SPA. ONL-A.LJ3RMSMARRIEMS .SHAL3 l! $ I'M P A.CP AT PRF,
POOL, ANDJOR SPA..14 00Yo1f LS
' xY67.[R:.Y.ECOdW LiOS 01, Av.A bai.�C.EN'J.4
114,000-00:
PlA,N CHECK FEE $999.445
CONSTRVCTION FEE 1010=-410'000 Q153.00 •
#.
ARRmI•AN1CA1,,FE ._POOL 101.0110-421.00A
EI.:EC RICAL.Ft-M.. POOL 101-000-420-000
PLUMBIWO PEE -- POOL 101m000-419-000 x":1.00
�� �� I V1 ,
1 I t
�v Y'
/, � ref • . ,
A BUB-`iMAL CON '87 UC ION AND PLAN CDECK
V48.45
x MS MY -.P* ,AT a FESS
$O. DO
TOTAL ]PER—Mr ]WAYS �UE NOW
8--44845
RECEIPT
DATE ^—••_
.$ �Y•
DgTE FINAL
INSP T�
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
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
cam/
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
�//
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:
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