9710-172 (RPL)LICENSED CONTRACTOR DECLARATION
U) I here -b'; affirm under penalty of perjury that I am licensed under provisions of
Z;i;gpter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
d r
LLJ034981 H 113108
oZ r_yDate /1 `'/ f Signature of Contracto � ------
QD O. r�_
J U OWNER -BUILDER DECLARATION "
HLU r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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).
cY) () I am exempt under Section , B&P.C. for this reason
u')
ON Date Signature of Owner
rn
a Q WORKER'S COMPENSATION DECLARATION
p I hereby affirm under penalty of perjury one of the following declarations:
Cr -
Lo Fa— O (.) 1 have and will maintain a certificate of consent to self -insure for workers'
XW LL compensation, as provided for by Section 3700 of the Labor Code, for the
r(D J Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
�,.p. U, Q Section 3700 of the Labor Code, for the performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
I� �= Carrier Policy No.
r` O GOI.I3'tNEAGLE INS, NWC42IM00
J(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
3
subject to the workers' compensation proyisions of Section 3700 -of the Labor
lode, I sAall forthwith comply with th' "thoo'se provisions. _.
�Date� r �/ ��> .7 Applicant '
r / I/ "/ L
Warning: Failure to secure Workers' Compensation coverage is nlawful 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) c Date O- /Ilk
°.
BUILDINGPERMIT
PERMIT#
CONTROL#
DATE f/ VALUATION
LOT 9710-172 TRACT
6172
JOB SITEi r
APN
ADDRESS i 695 C.riRRANZA.
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ESEQUEL CORONEL
CORONEL CONSTRUCTION'
38-C VRRNZsEC�
P.O.8O4i 391
LA QUMA
CA 92253
LA QUINTA CA
92253
(760)50446W CBL#
22161
USE OF PERMIT
POOL OMY
POOL. ANDIOR SPA
$,I?0f3.0fi I.S
F.,S'I lltIATEW COST OF 1 ONS`! RUC rION
1i�1N►11.tllt ,
PERMITFEE SUMMARY
PLAN CHSCKK 1: VF.
10140-439-318 SCrt.33
CONSTRUCTION FFE
101-000-418-000 $99M
MECHANICAL FEE, -- POOL
101-000-+121-000 524.00
ELECTRICAL FEE — POOL
101-000-120-000 $45.00
PLLJMBING FRE -- POOL
101 -MO -419-000 527 t10
SUB -TCT -AL CONgfRUC ION AND PLAN CHECK
1;259,3`
LESS PRE -PAID ITES
_%ol.GM
TOTAL PERMIT .FEES DIM NOW
5759,3:5
RECEIPT
J
DATE
BY } --'`
DATE FINALED
INSPECTOR
t
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
Final
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
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
Encapsulation
Gas Piping
Gas Test
Final
COMMENTS:
Final
Utilfi+ Notice
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Futures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice
CITY OF LA QUINTA
4'b4NG & SAFETY DEPARTMENT
CGN:�(Ti�?f°,'LLY
ACCEPTED FOR CONS R CTIC'i`!
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICAS+.:E CODES
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