RPL (0005-147)9t` " LICENSED CONTRACTOR DECLARATION
!:, Eby affirm under penalty of perjury that I am licensed under provisions of
iapter 9 (commencing with Section 7000) of Division 3 of the Business and
ofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
5:50498._ 13
Date ' Signature of Contractor
OWNER -BUILDER DECLARATION
12/51/2(,
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 STATS FUND Policy No. 046.09,0008134
(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.
gnature_(O.weer/Agent),--•--•---_,_.-___ ,Date, wr
BUILDING PERMIT PERMIT#
A.,.
DATE VALUATION LOT O147 TRACT
JOB SITE :"
APN
ADDRESS 81-8101 OU[@'.'i M VIEW LANE
OWNER
CONTRACTOR/DESIGNER/EN INEER
JMRRESCO.
A 0. 'TO .� C011TSTRZTMON
79.495 kTOR.L74JA1 PALM CUR
6407 P-ARSOWILI WAY
LAQlPNTA CA 92253
r3A:ft R3FMU:) CA 93307
(760)772.2546 C BIR 1451
USE OF PERMIT
MML A.NWOR SPA
POOL Sr SPA ONLYA"AMSf13ARR1EIMS SHALL ELS EN PLACEAT PRE
PLASTER rASPECTIaN. POOL RQUIPWM T ENC1,04URF 15 NOT I9c:LiSDED
12! TFi11S PEP -MIT
POOL,ANFDIORSPA LS
ESITIANIXIiD CO',Vf OF CiJkVfi°.PtMMON
164moo
PL4N C-HFX.K FEE 101.000_-4:39.318 5111115
COUSTRUCT1014 FRE 101-000.418-000 $171.00
MECHANICAL FEE -- POOL 101.000421000 $24:00
ELECTMAL I LL 6. POOL 101-000-420-000 545.00
P1ei1MBIT140 KIE - Pool, 101-000.419.0001 $27.00
T T.tJ-O"iAL COI,181'I;tUC"'}:ION M Jn PLAN C CX
$376.1'
ImS PRE-PPAM kM1bS
$0.00
NQ
i i
RECEIPT
DATE BY
DATE FINALED
INSPECTOR
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
Set
Beam
BLOCKWALL APPROVALS
Final
Steel
Electric Bond
Main Drain
Approval to C
POOLS - SPAS
1:"�. � _
Test
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
COMMENTS:
6-�l/i-U7
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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
Purl Cnvar
Test
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
COMMENTS:
6-�l/i-U7
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