0104-085 (RPL)(V aj
ouC)
Lr)
' LU
oZt�
to o
H
L
LJ UJ
I— a
M
LO
N
ON
U °)
12-
Q
It Z
Lo QQc
0
X tL
LU
0-JQ
mVU
O
Il rn H
Z_
ao 5)
r,C)
J
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
:-$hapter 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
193031 C-27 C-53 W/21/2(
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 Code, for the
performance 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.
WhIPT
(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 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. l agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
t Signature (Owner/Agent)
rf
Date
BUILDING PERMIT PERMIT #
DATE VALUATION LOT ��i�. TRACT
JOB SITE
APN
ADDRESS
r� �p� y ! p� A
R4'�.%�t'510,AN A.
OWNER
CONTRACTOR/DESIGNER/EN (NEER
«3 £3/A. X4:W0 WLTON
WATER CRIM170148 BY LAd".r?dWRI
LA QVINTA. CA. 92253
S4 . A AtqA CA 92705
C760YJ 7'7.1507 (MIL0
USE OF PERMIT
3' �0a7T-KI-"01OR SPA
P9��7?t"}l7$w.'r41.1gi,C�sL` 13.8Qir.(d�A,3454•y1ily}Sq�:IT3.1)-,F►�?(�F4,4.4,�gXtt�dAt1�R.Tigc33966E".Et3�i:'�OCYK(•sv
Y�t7 lt,
WAL4 A.1i,3.t5'•. 4' K:Z O!, b'+.Sv `,`-): %i�M1�4�P.."bAJJ�}.ASVl.V7 ii. .i':'Or.�C•ai.'7 F@94�Ir�l .:Jlr.i av
;i•'X UIMIAT PUPUMnEk INSPECTION.
VALYUATION %0D0.($ L5
4 . WALL L.F
V
F.6 ar .1kTKia COST 017 C.ONSTRUC;H00
„ 2.00
PLA:0 C`HWX FRE 301-0001439-318 5..M.135
CON :TRUC';t`)L2i+i FEE 101-000-418-000 $419.00
MEOHANICAL )?ER __ Pool, 101.000.423.00) Z44G0
M,.2':C:7'itr AL M..� -t POM S4.5.0
TIMMBINQ Far, POOL 101-000-419-000 WIN
(� d USS .MR -PAID FERO
7
$0.00
Kry FEF's DIM NOW
i
$78135%
JUN 2 1 2001
CITY Of LA OUINTA ✓
REC IPT
BY
DAT FINALE .4/
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slap 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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVAL
steel
Set Backs
Electric Bond
_
�q
_
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
'Nater Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
_
Gas Piping
-Gas Test
Appliances
Final -
ce
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)
i
Seat Wall
" Sunken Patio nflnitl Edge
BBD
e.C+ S"t 6' x a' Spa
Steps —. " Raised " Raised
� I �
Ed & Linda Knowlton
Lot 54 / 79-635 Baya
La Quinta, CA 92253
Date: February 3, 2001
Designed by: Jon I azzarini
Tel: 760-250-8810
I
ci
fs
CITY OF LA QUINTA
BUILDING & SAFETY DEPT
APPROVED
FOS ¢o9NSTRUCTI�--�
DATE BY
A RE -INSPECTION FEE OF
WILL BE CHARGED IF THE AP;- • , LD
PLANS AND JOB
CARD
SCHEDULEID
THE SITE FOR A
91SPECTION.
NO EXCEPTIONS!
Ed & Linda Knowlton
Lot 541 79-635 Baya
La Quinta, CA 92253
Date: February 3, 2001
Designed by: Jon Lazzarini
Tel: 760-250-8810
TA
FBUILDING
OF LA Q YI DEPT.
& S1
9NSTRUCT�—1
���o
DATE BY
A RE -INSPECTION FEE OF
LD
WILL BE CHARGED IF THE AP �N
. DEANS AND 1006R ADARE '113-1 SCHEDIILED
THE SITE
INSPECTION.
NO EXCEPTIONS!