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9908-159 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of G'r�apter 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 05tiI3It 0513 'I,/Ie !�1L signature of Contractors-•' 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). 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 Sianature 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. (l 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. 31AU0111 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 sub'eet16 the workers' compensation laws of California, and agree that if I sfi6ulYlbecome subject to the workers' compensation provisions of Sectio 00 of the Labor Cpde, I sh 11 forthwit 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. r 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 reelatarfg to the building construction, and hereby authorize representatiyes�o his City to enter upon the above-mentioned property for inspection•our ©ses' Signature (Owner/Agent) - Date BUILDING PERMIT PERMITN DATE 0,9,11911 "VALUATION S9 449)" LOT TRACT eT� JOB SITE ADDRESS 0 . —765 LIG APN OWNER CONTRACTOR / DESIGNER / ENGINEER ITA PO LS & SPAS 79-765 LIGA, 74-725 JONI DRIVh, HA t.AQUINTA CA 9.41253 PAl',rt1I3wir CA 92260 0W340 -9W CI3l.111 355 USE OF PERMIT ' POOLA�,��3f:.t,��ltytC.' iSyF3.A•t Y �n s } •-�r�g Y?a2�y��x t��; 1Tny �»�., 1 a� .%�tO�.. IVN D .7C"i�► ONLY, ..Ai+i,�V i!EiR ,HIi`i.�`if..?ti4 d:171ALfu&.��. 1RC.�f•J ilEd.".f./.i"'L�ii . M0_,'-4iLA!rI R INSPEE.C'i'1.014 1100L ANIXOR SPA. 9,800.00LS 1 3 A 4,12ATED 'C0+:i-T Or i..iUNT ► d RUIi..�.9 nON 9,sfaw PERMIT FRE SUMMARY' PLAN {:frlECi°'a• FEE 576.0 Z�N�yl+7F+13�9��gp !(f 9y $r„^.l^tl`^� 7C��aty"�f�g:T/}C�fe /Rift-�2.5y3••4(i�/4�3�ty1 dR)J.'�F!/1J,�A'wr�V.. l.'/.:ri.:. —POOL L 101-000'42.1.-lif.N.� � SZ11. 0 Fl:,1:CTRICAL k"# it: -- ;POOL • 101 00-420-000 545.0 PLIUNWIM FEE POOL 101w000-41fXMI SU -.6 V,IAF.r CON f 5'1LI iL ONN a' N1 -.J PXAAN 04t CK .l IR9.05 LESS FIR '- jUD FEES $0.00 .. k .. q, 5 W�',tl l ERf M, 11' FE.C.f0y JE NOW $284.. ..*��et tit# RECEIPT DATE BY r j' DAT NAL INSPE TOR 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 Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 COMMENTS: 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)