9909-399 (CP)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Imo— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Profepsionals'kCode, and my License is in full force and effect.
F n�itt C) LiceiGndL�y 4 LLiic... Class Exp Datoeo' �'
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SI2'8 - CS3 I VI?l/ LAR
Z rrZ �a e Signature of Contractor
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co OWNER -BUILDER DEC ARATION
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W LU �I hereby affirm under penalty of perjury that I am exempt from the Contractor's
to 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
Ctel
c� LO am exempt under Section B&P.C. for this reason
N Signature of Owner
ON
Q)
d Q WORKER'S COMPENSATION DECLARATION
p < IM I hereby affirm under penalty of perjury one of the following declarations:
Hp ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W �: compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q Zction
`mance of the work for which this permit is issued.
M Q UI have and will maintain workers' compensation insurance, as required by
Q U Q 3700 of the Labor Code, for the performance of the work for which this
li rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
`t Z Canier Policy No.
O STATE FUND ff &95 -=16168
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 thivel•mit is issued,
I shall not employ any person in any manner so as to bec6me subject to the
workers' compensation laws of California, and agreea if I should become
subject to the workers' compensation provisi
onf;Sron 3700 of the Labor
Cods, I shallforthwith comply with those pos.
Date: 1 Applicant /t
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 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. I agree to comply with all City, and State law�'relating to the building -
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectio purposes.
Sire (Owner/Agent) Date /414/f f
PERMIT#
BUILDING PERMIT
DATE I VALUATION LOT TRACT
JOB SITE
ADDRESS
-
7—
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MARVIN HOMES
CALU RNIA'PtaOt..S &SPAS
79-M CALLE =ADO b'M 201
74725 JW DRIVE. #A
LA QUWA CA 92253
PALM DESEitr CA 92200
(760)344--Sh4W CB110 W
USE OF PERMIT
PWL ANU OR SPA
-
PCkC SPA ds B8Q- ALARMS ANVX0R BARRIER. REQUIRW FOR
wF.;.,LaThi< mwwnow
P00L AN UOR SFA 19,4.00 LS
1i»'ITTKATED "7' OF CONSIV[tL"'i ON
'19)M.00
PERM fT FEE SUMM.ARN'
PI.AN (-I*CK 1M IU14XX)-d 338 U34AS
c'tlN.TM19 rfrIN F'(T 1oll-0*41K-t►t'Yti f1107,00
MM, IANICAI. M, . • POOL 1101-M-4211-000 $24.00
W.ECTRICAL FIE -- F'#,X)L 101-000420-000 $45.00
PL13ltitf3tAB:4 Ffg- P(X). 101.400-419-ODU f27.txf
9.1111-TCT1'A[,C ON'S1W.WTION AND F4—AN MECK
X437 ss
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT-rFM DUE NOW
S437-55
RECEIPT
DATE
BY; /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Oack,
Underground Ducts
Form. & Footings
Ducts
Slab 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 I
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
Encapsulation
-
+ .5 515
Gas Piping
Gas Test
Appliances
Final
Z 6- Q
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: