0006-386 (RPL)U)
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LICE SLED CONTRACTOR DECLARATION,' •.' + .
ry l here y a irm under'�rerr�tty=8f perfuYry,that'I am licensed under provisions ofr"�
r•Chapter49f(6ommencing with Section,7000) oaio
yiXisn 3{of the Business and,,,' -Y
Professionals Code and mry cen_se is in full force and effect ' ti, y
Lia Class • %s' • Exp Date
`6349€31
Date Signature of Contractor r
R 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(,) . I,„as owner of the property, am exclusively contracting with licensed
' contractors, to, construct.the project (Sec. 7044, •Business & Professionals
Code) ;
ftO I am” exempt under Section •----v,-B&P.C. for this reason
Date Signature 'of Owner,
WORKER'S COMPENSATION DECLARATION
+`ly,hereby affirm under penalty'of perjury one of the following declarations:
ip+ ( ) : 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.
fhave and will maintain workers' compensation insurance, as required by
Se6iron__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:
z'Camer. "STATE FUND r Policy No. 154293740
-QThis section need not be completed if the permit valuation is for $100.00 or less).
(1) 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 shall forthwith 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
.;of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for ,'a • permit subject' to the conditions and restrictions set forth on his.
application.
' 1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&'hold harmless the City of La Quinta, its officers, agents and employees.
2 °Any permit issued as a result of this application becomes null and void if
work, is not commenced within 180 days from date of issuance .of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
rritiaFs'Y.,r�s+ ..,,,. _...- - •,�-.-^- - - S,Y-a °i"*9 'PERMIT#t .« �„i$''l
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ADDRESS • 51-G05 A VM..0)A RAWj�REZ •
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CONTRACTOR/ DESIGNER/ ENGINEER6 h•t 1 < vrr� •w
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PO BOX 3€38
51.5403df3C� R
LAQM4TA CA 82253
LAQMITA t .�; o�A ; �h6233. ti'�
(760)364-4604 C 13Lib 2261;
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USE OF PERMIT
POOL AN1)/01t SpA
POOL & SPA Olds,Y-ALAR.MS/BARR.IRRS SHALL BE iN PLA.CE P•►T PRE rte° '
- PLASTER rNSPE;C 1 ION,POOL 1rQUIPME-0t I;,1.1CLOSURE 12 NOT, iNCLUDED '-},r�'r t�"�, � •
IN THIS PERMIT • � � �c.� 1
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POOL ANDJOR FPA Ls
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EffhM IUM COST OF i°0N8'°k'Tsl7 �31vT
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# .?t� 10)a.00
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PLAN CHFCK FEE 101.000.439.318 ; $64 9$
CONSTRUCTION VU 101-000-4.18-000
MECHANICAL FEE -- POOL . 101.000.421.000
POOL' 101-000-4.20-000
ZLECTR_fV.AL FRt --
PLAIMBINQ FEE -- POOL 101-000.419.000 $27,44
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3UB-I't.rfAL CON'MLiCMOW AAT1.) PL.W CklF-CK
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TOrl'AL. POW11"EMS DUE NOW
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RECEIPT
DATE
DATEFINALED 7FINSPECTOR
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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
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 jig
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
i
Gas Piping
Gas Test
Appliances
Final
-5
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: