0112-141 (RPL)r•*'^-^�'",+`. w::a..•.!!'.-f.»+.i."'rc,......."'','4i+i%�^.'::SLS..,i�•.�t.:i''�""`X�-•°�'Ii..-"f�i+*r.,.•. ...SL• -.+s yti�;�t "{"';s'7�ftt �"';
LICENSED CONTRACTOR, ;DECLAHATIvI.4+
uj `I hereby affirm under penalty of perjury that f am licensed under,provisions of
I— Chapter 9 (commencing with. Section 7000) of Division" 3 of'the Business and
W Professionals Code, and my License is in full force and effect.'"F
C =) ch License # Lic. Class # Exp. Date',,
Awa LLI��!_2 `74'• + ,�3 C: T r' a�il3
Z r --bate Signature of Contractor t
�O.�.a
J V OWNER -BUILDER DECLARATION t
uJ W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a- I License Law for the following reason:
W
Z ( ) 1, 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
xc Code).
co O I am exempt under Section B&P.C. for this reason
LO
n N 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. EXEMPT 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 hall 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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 his
application.
1. Each person upon whosebehalfthis 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 becomesnull 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 fop ip§'pection purposes.
Signature '(Owner/Agent)
I...,PERMIT#
'BUILDING PERMIT"
-
DATE f 1/ VALUATION qA� tOT �� TRACT
JOB SITE '
ADDRESS � a ky ��O e
C3-�COM,
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RIC11y, COCIM S POOL CgCSNW
COTYKF
4.511 F,'' SL S 1PUXE3 RD SfVt,,A
.0 ,. ��A+F'I '`'�° Cly
1?AI,.'K ,--YR ',�3 CA, 922&3
(619)3z01n,4030 , C.S1 z< 41316
t. .
USE OF PERMIT
P- 0O:, AMI(C) R hIPA
POCIL''PA. ALARIf3:aIHAlztcAMSSHALLASEiN PLACE XY PRE--KJISTER, ;
F001, AND/014. SPA A000,60 LS
.FIST IND C:fiS1 01 C O nIRUCLION
P�t�RWr FYW, arUMMA RY
PLAN C111FIXY' ITY,01 -W043-P-318 $168,03
CONSTRL3CTIt1NRE 101.000-418-000 $25511.50
Mt?:tsHANICA, , kE -- POOL 1011.0500.421-r1QDA (24,00
BLECTRIC:AL VVIE •,, 1.001. 101-000-4,20-00,Q` $45.00
1,)LrtJM.l Dfq FFA•. - Pon.1, 10f 1-0 00.419-Chd WA
9
nFc 19 2001
Cra YOFLAQUI �gaT;A ,
" nz$•i W, -J OTA 1:. 6.`a.ON�fSW(;3�t;'1`.�t` N; Q'C!UK C1- .?C'1-
'�':�I.`�+.5:�
ryyn7y M-but L.�].
xWiE ut1f0"VY
C
i
RECEIPT
DATE �+ /� // I
l7 r� ll;�j
`B�Yi%'. �'( �—!'
7 i
DATE FINALED
INSPECTOR
a
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
vc — 0s
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
O/- 43 —OZ
Underground Plbg. Test
Fir,gl
Gas Piping
{ PLUMBING APPROVALS
E�ectricsFinal
-
W_ste 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
•
Findl
Uth,y Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Volta a .firing
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
leic-KI ;7
/6 /J� CITY OF LA QUINTA SUB -CONTRA TOR- LIST
JOB ADDRESS � o 4 7 PERMIT NUMBER D OWNER /'► �_S BUILDER O ��
This r be s w B II o s la my persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information renuesterl hPlnw mist ha enminlatarl h., fan— L:1_o.:_
Trade / Classification
Contractor
State Contractor's License
yr-Pp...a..l. WWI IIG W "Ut all duuuptduie response. .
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. (e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
le.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
-
Exp. Date
(xx/xx/xx)
EARTHWORK (C-121
CONCRETE (C-81
e
g OL
FRAMING IC -51
STRUCT. STEEL (C-51)
MASONRY IC -291
PLUMBING (6-36)
�� 4�E:11� _
�
�/
a 4
�00,
G�2
Q •�
� /Z �
-10W44, PLASTER (C-35)
q10
DRYWALL IC -9)
h
HVAC (C-201"
•
4
ELECTRICAL (C-101.
ROOFING (C.39)
SHEET METAL (C-43)
FLOORING (C-15)
i
GLAZING (C-17)
INSULATION (C4)
SEWAGE DISP. (C-42)
PAINTING IC -33)
CERAMIC TILE (C-54)
CABINETS (C -e)
FENCING (C-13)
-
LANDSCAPING (C-27)
POOL (C-53)