9808-226 (RPL)H
CO
N CO
W
�vLO
r— LU
o Z ti
C 0 O
I— (D
IW— a
U)
Z
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 Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
611611 C:53 f 351199
b'Date "f 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
pelf9mriance of the work for which this permit is issued.
00 I have and will maintain workers' compensation insurancei as required by
S &tion 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 Policy No.
CLARE-KKAN NAT101 01KR0001440
(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
eject to the workers' compensation provisions of Section 3700 of the Labor
ode, I shall f rthwith comply with ,tGe p�r9visions.
Date: �/7 - Applicant rt¢
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, indemnity
& 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 representptives of this City to enter upon
the above-mentioned property for ins ectio %63 f. es-.
Signature (Owner/Agent) % Date
BUILDING PERMIT PERMiT# °°NTR°`
►
�A�t1tL-x24.o
fP
DATE VALUATION 9 5.ufX1.1'.Qi LOT TRACT oor' ,
V
ADDRESS ;5,5-590 C1}1E.RRY HILLS
APN -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
t OV.F, INC.
f11CINITY?L�, F'r; K"I S & SI ASI
Y)AW5 fv10( R*ri'A1N SHADOWS RD
FIX:). BOX 1'1191
LA (; VINTA. CA 92253
L.A QUIN`+:A CA. 922fK1
116(313o(i-�1gfti5 CiFti..f� i4!lS
USE OF PERMIT
PWL AiNjSlC. k.':PA
?WL AND VA ONLY. A,I..iTWS ANTJ (.iR BARRIER REQUIRE -D FolJ
POOL A',Ti iOR SPA i5,ih`30.00 i
&STs,NIXT ` D COST OF C•.ON 'a RUC..ION
L `111d'iI?.SiU
PLi RIi IT PRO, SUMMARY
PLAN CHECK FFR, 101-()W-439-3318 SlUS.tU
C'+7NsiTR1K'if,{ll3(1F(. tl)1401-41;1-131){t 5tfi?.tt+?
MECIIANICAL VEE -- POOL 101 -WO -421-000 S2t.ist+
EJ_P:C"1'RICAL17f;E.-POOL 101-000-420-000 �S.tICi
PLUMh[N(J );rP:F'. -- VrL 101-0013-41119-000 $:27.00
t'
a
' 11'- i"t:IVA I, CQNq 1'R J(,'T10NT NNID PL C1 -1I -XX
LESS PRE -PUD FEES
$10 1-0
$0,00
�8
1995 �� 01'All, jPRkMJ�a•,� C -P S DUF NOW
s.si►
SE['
OF 1.3-
ECEIPT
DATE
BY q
DATE FINALED
INSPECTOR
ri
INSPECTIOO N RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BULLDING APPROVALS
MECHAMCALL, 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
Final
BLL®CKWALL APPROVALS
POOLS _ SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMf MIG 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
04
Final
Final
Utility Notice (Gas)
ELLECTMAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
`A'tility Notice ;Perm)
C®R�t`J[If��fS:
_-.