9808-074 (RPL)" LICENSED CONTRACTOR DECLARATION
« I hereby affirm under penalty of perjury that 1 am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 2vm Business and
Professionals Code, and my License is in full force and ct.
License # Lic. Class Exp. Date
5 936 C53 i I/30f9tz
�' Signaturef ntr for
Date o Co ac �
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
compensatiori, 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
p rformance of the work for which this permit is issued.
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.
STAIFUND ( 344036-97
(This section need not be completed if the permit vs3luation is for $100.00 or less).
() I certify that in the performance of the r for which this permit is issued,
I shall not employ any person in an anner so as to become subject to the
workers' compensation laws of iforrtnia, and agree that if I should become
subjectheiwor, rs' compensatioArisions of Section 3700 of the Labor
�C6de, left
4f� h comply with thos Ions.
Date: v' Applicant l
Warning. Failure to secure Workers' C mpensation 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. a
M
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 CINA d -State laws relating to the building
construction, and hereby authori resentatives of this City to ///e ter u on
theabove-mentioned property for Ins ection purposes.
f
Signature (Owner/Agent) Date
PERMIT •s9 CONTROL#
BUILDING PERMIT
..
DATE VALUATION $.I2,80f).Q0 LOT TRACT
7435
99
JOB SITE
ADDRESS 53-619 AVENIDA 11 AMIREZ
APN
J
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Ri:CTE1.0
rAM1LY POOLS CONS"'f'RI C''TIO.N .
33-695 AVL'NMA RAMI EZ
333U0.AVENIDA ItA112i.KE
LA QUINTA CA. 92253
LA QU1NTA CA 9215
(760)_'%4-N555 CKill 2893
USE OF PERMIT
POOL AND(-* SPA
POOL ONLY.. ALARIMS AND OR BAt•2RTW11 ARE, FcEQUIitL-!'i_--) %Olt
' 1�h-PLASTF1� 1N�EC"rfON
POOL ANT!/OR SPA 12.800.00 LS
:.. S1"1MA'lz'ED COST OF CONSTRUCTION, ..
'A"2,8It0.W
PERMIT FEE SUMMARY
Y
PLAN t:W.CK FF.E 101-000-439-315 593.60
CONSTf lic-1"ION FT:F; 101. -000 -418 -ow $1,14.00 .
A&M,IA.NICAL FEE -- POOL 101.-011.9421-01X1 3241,00
hl,ECTRICAL FEE -- POOL 101-000-420-000 W.00
PLIRABING" FEE -•• POOL 101-000-419-1900 $27.(1()
.
CONSTRIKIION AND PLAN CHICK.
%333.710.
4I'� 1...LSS PRI, -PAID FEES
$0.00
AUG 11 1998 TOTAL PERMIT i' FEEDS DUE .NOW
$333.60
is 0
t v+
J
Q _ ■T •
h
1iECEIPT
DATE
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
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Set Backs
POOLS - SPAS
steel
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test 17d -
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 c ,
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: