0011-241 (RPL)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
"6891 4130102
Date 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 Cod e,• for the
performance of the work for which this permit is issued.
(k� 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 Policy No:
STATE FUND
(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-Ishould become
subject to the worker's' compensation provisions'of Section 3700 of the Labor
Code; I shall forthwith comply with.those provisions. y'
Date: /+., Ff. 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.
Signature (Owner/Agent) +� �*""°` � a"° "' Date :7*/
BUILDING PERMIT PERMITN
DATE VALUATION LOT 0011-241 TRACT
I WS
JOB SITE
ADDRESS
APN
79465 UGA
OWNER
CONTRACTOR / DESIGNER / ENGINEER
iM.gVORITIAMO c SY5 c'
12,8. 0 :POMTE DO, REAR, a°3l'Yfn;- 2001
74 -7l; 102a )RA% #A
.DM,. MAR CA 92014-304-0
PAIM M3RAT CA. 92260
(7 ?)?4t?^�9000..
USE OF PERMIT
PCIOLAPA. r?s.LARU. AARR19kS SHALL BF, ng f-'I:AC .A Pk1P;-PLA,3TY,12 '
INRIPE .'TION. POOL..EQUIPMENT DId.I.t;1SURE 19 NOT FRC DED,
r
POOL AX=R SP1? 14=00 LO
WMAITO Corr or, -CORSTRUMON
15A96.00
PLAN IIECK FEE 101-CP00,439-318
CONSTRUCTION FW, 101-000-418-000 �I7l.ftfi
MKt4H+,l I CAL ME -- FOOL 124,00
L YX,TFI.ICAL. F=.. POOL. 301-(M-420-1300 $45.0
PLUM0540 I'OI-• POOL': 101-000-419.000 $27,00
9U:ia� `lMAL t° C1NSTKIGMC1N AM PLAWCRECK
U33 PRE-PAW111M.13
$� (l�.. DTO
. •.
VjYL;rcLk wJWSm dfLvo
S378.15�
RECEIPT `
DATII
BY
FDgf FINALE
INSPECTOR'
r
A.,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I 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
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Hacks
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
Appliances
Final O
COMMENTS:
r
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)