RPL (0207-079)LICENSED CONTRACTOR DECLARATION
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. �-
License # Lic. Class Exp. Date
65612,8 3 i'ac s 3 i ez
Date 7 — 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). '
() 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 Di'ATE ('01APENSATI Policy No. ifl00�14w= i-:<:
(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' compensation' provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date:1?. r?% Applicant- dd—
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 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 9 P Y Y 9 9 i,
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fr Inspection pMses!
Signature (Owner/Agent) .01 Date—
PERM T#
BUILDING PERMIT
0207-079
DATE VALUATION LOT TRACT
JOB SITE! �� s
ADDRESS 7#;�•�' � LMd mics ,Awpmw.
APN
OWNER A CONTRACTOR / DESIGNER / EN 1NEER
CEVI URY' s':R tikiILL COMMUMUM CALIFORNIK PCIOLS & 0 -PAS C t:: P ?dAN CO.:
I/53350,°D°`iIMf, 31M WO 747i5 10NTTFYM, SWE{d
1pN A:yd:IR19CA 92408 PALM QiAZT CA $1260
(760),340.9000 CDT-- 00353
USE OF PERMIT
POOL.&Mi'OR VA
POOL, AWD HPA ONL- n Alf,&R,ldlWAMM Sh&L.L BE INN 101 ACE PRIOR
TO PREPL lS RII rK3PRWT10N. KXX C QiltP;viENT EXCI.X)IN RE NOT
114CX,UDZZ) W PERMIT. -
P001, ANCVOR SPA 11,000.00 Ls
`e
PLAN CHECK RE V �• �i. DO
C.:C7k3`a"tiTZ .I3MON r3?E Yt 3'�t €}0 t -C►tifl $1';> p.utl
M1CH.1`<id'ICAL ) _ F ., P001, 101-000-421,000 $240
SLE4:TMCAL. P*FZ — POM, 101-000-4.20-000 $45,€119
PLUM NO FEE .. WL 195.0()0-4,19.000
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A)l.!B-fi.MAL Ce.f'N1801AMMOJLVp.tY9Md.o.C`"i..a'21`7 Cd.�C%C:K
LES.17'.TXRE-PAID T i1MS
i.
tt—
RECEIPT
DATE 7
BY
DA FINALED
INSPECTOR
W.-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
' DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade i
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 ElectricJ�-
S
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lint's
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: