0307-312 (RPL)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
O =) C) License # Lic. Class Exp. Date
LLJ
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o ZO f Date F •, C ' "-) Signature of Contracto
UOWNER-BUILDER DECLARATION
HWW r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
C'•) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
O)
CL Q WORKER'S COMPENSATION DECLARATION
p Zcc I hereby affirm under penalty of perjury one of the following declarations:
Lo Fa- O ( ) 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 � Qperformance of the work for which this permit is issued.
CO Q U 1 have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
L rn F- permit is issued. My workers' compensation insurance carrier & policy no. are:
?• z Carrier SUM V1,13140 Policy No. MIN1,14-2004
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(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
subject to the workers' compensation provisions of.Section 3700 of the Labor
Code I shallforthwithcomply with th�gse provisions'/-
Applicant
,,,Dace:
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 representativesiof this City to enter upon
the above-mentioned prope y for "nspection purposes.
y�Signature (Owner/Agent) ��j•!?f Date
T1
rJ PERMIT #
BUILDING PERMIT
C007-312
DATE VALUATION+•] rAl�ts�)�T LOT TRACT
JOB ADDRESS '�3�`��3c°fAet/t�ir.'%f7Y3ft3
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
54.6A0 ,t;8nDARM-110
81CRIMAM WAY
dh QU1ryA CA
ry20y
C.A. 92201
('1760"'3167-1637 C.BLA 2638
USE OF PERMIT��
POOL ANI VOR ZYA
�i•.,t—Rkd
Yl:l.13.. ,143. Xri.iV7�: tit; 2_ tttt tit s.•d
POOL Al.rVORS)"A MOM 0 1A
ErM1,F'r,TEDC01,41J Or,
PLAN (311ECi( FES 39-31 R tk] i'7 rs►
C:011NTY.U1_'T1f3iNFIYF: 18-000 Si8:4tt?t
AMii.C•R!!s7a1CAL FE:3 ,- POL+lam 111.71 ItJ0 :.,•? x:1.000
2U.`wC' U(t 'AL 5� 1�; �• CdOY. 9.tr'� - �i,: r: ,ii1)i? $4`S.OU
1111LI M13r4dO'1F1+. 1 •- POOL V 5-000Ai19-000
Mik:O,.1'fAL COMI'I°I`UC!""Al ,k+WD '.,` 4,.,' CR KrAc
k'r. t�iiC� I' ° 7'I' 1�" ; + t). Ole. i Ci t%•
:5,.00
RECEIPT
DATE; n
BY
DATE FINALED
INSPECTOR
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
t Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
s 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 p
.yas Piping
Gas Test
Appliances
Final , —7,
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:
_
FROM RAZO POOLS FAX N0. Jul: 23 2003 10:33AM P2
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LA
Razo Pool Construction
Lic. No. 573948
(760) 347-1617
David Razo
To Whom It May Concern:
I authorize Brianna Razo, my daughter, to purchase (pull) a permit
for job site on Rubio Ave. in La Quinta, California on Thursday, July
24th, 2003.
Signed: `
David Razo, ontractor
7/24/03