RPL (0208-004)LICENSED CONTRACTOR DECLARATION
-Vhereby 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
614611 C��-�,or,. (13/31/3(
Date 'I Signature of Contract_'' ''" �
rte,.
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 UT.ATE FUND Policy No. 04610467f12
(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
Codelh I I fotfyith comply Wlth th_Qse�provisiopsa
Date:,' �� V Applicant ' " '�
Warning: Failure to secure W'ofkers' Compensation coverage Is s un aRand
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(p—rop'erty f6or''nspection✓purposes.
Signature (Owner/Agent)1; -`•-�- Date
.r
BUILDING PERMIT PERMIT#
WN -164
�"
DATE VALU!r710N p LOT TRACT
6 '
JOB SITE
ADDRESS..2W- MIMrfE11 .D V1-LLF.t.G'1u
APN
OWNER
CONTRACTOR/DESIGNER/EN &NEER
19.EOHOUMM dbR WESUUM PALM(N
10t MC"` rf ME PO IX & VASA
:I NIM014 OF D.1:Z.13Gb1;`Lt'LM
R01 BOX 1791
Mv= CA. °92.600'
iAQUDATA CA 92253
(760)36045185 C'16 1945
USE OF PERMIT `
POOL AND/0A VA
POOL,. a1XD SPA ONILY. ALA1MS1k2.R RWERS SHAU, BE JW PL.jPi,.CE 3'f2. Ort
TO 4'aRi PWI ER i'tiSPI;tYTKIN. POOL EQUIPMENT &XL03UPY,'W T
MOLAAiWOR 13PA 1ANDA LAS
XMWATM) COST 00 CONSIRUCETON
PERM ':rs'ER WOTYWARY
irim Crlf OY. Me 101-M-439.318 $304.30
Cf)1J;3TRUC,'MONA,` VNE _. 104.-000-416-00(1 V619.3
C'HAV 1CAL: RZ.•. FS00L 101!? 00.421.OW $244.10
J8LZ,C:'i'kIC.%b.PK3—P001, = 101000-420-0030 us,.00
PLUMBING FER __ POOL 101�,.000_419_000 sor Do
D e
0 2 2002
" CITYO, F�LR4UIN''
(A
p G'dV..AY 00 CI- 161,1-
$163,30
TMAL PMIVXAT MEN DIM'NOW
.� m
RECEIPT
GATE
BY
D2 FIN EDL�
IN PE O
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air E'
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
- • POOLS - SPAS
steelA . I - 9--
Set Backs
Electric Bond
e
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
_
PLUMBING APPROVALS
Gas Test
Electric Final
`EJaste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Saower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
_
Gas Test
Appliances
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)
Final
COMMENTS:
14
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CITY OFa
LA QUINTA C� �
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
BY Ccp
ENTRY
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11/08/2002 10:24 7603603435
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TY OF LA QUINTA
r ,G & SAFETY DEPARTMENT
777-7012
}JSP ION REQUEST LINE
� ,/�� 777-7153
PAST 9N JOB IN CONSPICUOUS PLACE
INSPEC70R MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 56-250 MORFIELD VILLAGE
POOL AND SPA ONLY. ALARMS/BARRIERS SHALL BE
IN PLACE PRIOR TO PREPLASTER INSPECTION. POOL
EQUIPMENT TNCLOSURE NOT INCLUDED IN PERMIT,
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U10 PLUMBING / WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
VU NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL I PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD, DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS I STEEL
BOND BEAM
POOL SPA I WATER FEATURE INSPECTIONS
PRE-GUNITE SETBAC 3 ')
U/G PLUMBING
U/G AS 7.
U/G ELECTRICAL
PRE -PLASTER (ALARMS/ BARRIERS
FINAL. INSPECTIONS
TEMP USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL JOB COMPLETED
ACL CONCRETE FLAT WORK SHALT BE PLACEb