RPL (0007-176)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 Co e, and my License is in full force and effect.
License # Lic..Class Exp: Date '
614611 .' C5. j�°
Irk Y
Date /Signature of Contractors//
�.✓
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 A Professionals
Code).
O I am exempt under Section B&P.C. for this reason
Date Signature of •Owner `
.r
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.
(. J (,,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 WIL1dAMSBUR.01NS, Policy No. T COI iY�34=91
(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;l sh1l fo h ith comply�with those provisiorlS! '
Date I' (J � Applicani--k- 'ate y>'_"'""".'""
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 personat
whose request and for whose benefit work is performed underor pursuant to
any permit issued as a result of this.applicaton agrees to, & shall, indemnify
& hold harmless the City of La Ouinta, 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. -1 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 poperty for ins ection purposes
.� 7_,- vo
Signature (Owner/Agent) � Date
BaUILDING PERMIT PERMIT J/
rf
DATE— VALUATION ' LOT 00071.76 TRACT
JOB SITE
APN
ADDRESS V^iM.9 Xi%CJ i_AUq S1 AD'O S.�. OAI)
,OWNER
CONTRACTOR/DESIGNER/ENGINEER
UMITMMIJ C6148TRUIMON
MCJTVYRE PCOUS & SPAS
74.7851- 11- WAY 121 I31,TZE- 105
P,O. DO.Y.1791
DIDLW CA 92210
1A QUWrA CA 92253
x'1(0)360•,3585 CBVi, 1945
USE OF PERMIT
FOOL AND/Cly. `OPA
1P60L &SPA. ONLY•ALAR MSMARRIERS SHALL HE IN PLACE AT PRO
PLASTER INSPi CT ION.POOL EQUIPMENT KNPLOSUPE IS NOT INCLUDE
M THIS PI MIT
POOL .A1` DIOR SPA t3,040.tiil :Ia
PER W., FJM SUMMARY
PIAN CHECK 101.000.439.318 $100.30
CONSTtZUCTION P7,9 101 -000 -4:18 -CCTe? W2.00
MECHANICAL FFR — POOL 101 X000-421 y000
KL9CTRJC:AL :FEE — POOL 101-000420-000
PLUMBING YZ . — POOL 101.000.419.000 $19:00
> �
SM: TOTAL COA07RUCTION MTD PL:.AH CWrk
$363.30
RECEIPTDATE
BY, _ y!"
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
SefBacks
Underground Ducts
Fo s & Footings
Ducts
Slao 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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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:
1
CC a.5 -e C
(�
. ,.
LICENSED CONTRACTOR DECLARATION
I hereby.�affirm,u'nder penalty of perjury that I am licensed under provisions of
Chaptoa 94'commencing with Section 7000) of Division 3 of the Business, and, x
Profess anals• bode, and my License is in full force and effect.
Lirt;ense # Lic. Class Exp. Date
614611 . C53 03f3112C
Date 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 perfo,rmance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
T,�I LI.,I.hI�Sl.�il)Ik� O IRIS, WC'0I 17934-.01
(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: 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 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.
Signature (Owner/Agent) Date
,y BUILDING PERMIT PERMIT# 4
.DATE VALUATION LOT 00074,76 TRACT
t3'1J21f2dDC U51000A X)
JOB SITE
APN
ADDRESS 50405OYNAIN SH4OWS ROAD
OWNER
CONTRACTOR / DESIGNER / ENGINEER '
1"10 MW C'fONS=CrlolJ
MCINT'Y'RE.POOL-8 & SPAS
74-755 FTI %J. WAY• I1 19IM, IID5
F,0- BOX 1731
:t1+i'.L�1LtN VM.L8 CA 52210
:LAQT:1 rnl. CA .92253
(760)360-3555 Ci vt 1541
USE OF PERMIT ,
POOL AND/OR SPA
POOL & SP.A ONLY-AWMA MARMIER,.i 3%'1AU, BE IN PLACE AT PRrg
PLASTER YNSPEC'i'16N,POOL EQU1PM,9147 ENC.LOSURE IE NOT INCLUDED
W THIS. PF M,1T
POOL AND/OR. SPA 15,f1tifl,fl0 S.S
1951"175'1.3 COS"f O1' CONSUZUC'1'fON
151000.00
PLAN CHECK FEL 101-000.439.31'6
CONS` RLIC'TION FRE 101.00e0-4418-000 $164.00
MWIiAHIC.AL, FEE -- POOH. 10.1.000-421.000 �14,fl0
91=111R.1CIA1. PEX.. POOL 101.000-420,-000 $0.00
PLUMI FHO FIFE -• POOL 101.00-419.000 527,00
4MTAL, CONSMUc;"HON ANIS PL KW CI UMIC
$30.30
LEISS PRE -PAID FERS
50.00
TOTAL PERAU ° 3=6.0UB' NA SSV
$ IM3 V
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
` BUILDING APPROVALS
MECHANICAL APPROVALS
S'et 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
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
Gas Piping
Encapsulation
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: