9902-110 (RPL)LICENSED CONTRACTOR DECLARATION
I, I hereby affirm under penalty of perjury that I am licensed under provisions of
^ h -N• �`_hereby
9 (commencing with Section 7000) of Division 3 of the Business and
N W L ` Professionals Code, and my License is in full force and effect.
O =) Cr) License # Lic. Class q Exp. Date .
ir�_ CY LO 90, C417
63
IV
Z t� at Signature of Contractor —�" Z
co
U C> OWNER -BUILDER DECLARATION
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U)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).
() I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
CJ Q WORKER'S COMPENSATION DECLARATION 4"
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:
Cartier Policy No.
(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
C�ode,Jshgll forthwith comply with`those provisions.
Date:p",Y/ Applicant .
Warning: Failure to secure Workers' Compensat.... coverage is unlawful and
shall subject an employer to criminal penaltiesvnd 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
constructi6n, and hereby. authorize representatives of this City to enter upon
the bove-mentioned property for Inspection purposes.
`.
Signature (Owner/Agent', � �� � Date � � �
BUILDING PERMIT PERMI9902r1to
40
DATE J J VALUATION $ 13J) LOT TRACT
.J0,tN.J
JOB SITE
ADDRESS �&.", O RAY�'iU"V LANG
APN T
,OWNER
CONTRACTOR / DESIGNER / ENGINEER
:I NI FE.DOR
IDATE PALM EN'I'I:•.I1_PRISFS
7$-990 BA YT EUX LAN%
8I-WNIOUN AIN VIEW LANE
LA QUINTA CA. 9.725:3
LA P jt71WA CA 92253
�7C�f1}39ti-17�F MIA MRM
USE OF PERMIT
POOL AWWOR Pi
POCt1, S11A OMLY — Al.4ki UMBARItURS 10UST B.ts IN PLACE AT
POOL AND OR SPA 13,00-M 0-M US
g CRMI L ER c' ((Ap VIN,p ''`` ((t;n�9)•i,YAi-!I.t��L.S
PL, AN C;REC,fk FM& i�7� �t9U-dig-3t� Sr�+.6t�
f�,C,?N'ii R1 IC,"F iOIJ ITE X14+; t14)
Mr.304MOCAL t`+M, -„ POOL 101.000-4211-000 $24.00
EI.�•.t't`AICALFM--POOL' loo-OW-4120—Wo S45,O)
PLtxX031NO FEF. __ PCYX I0I-0004al-ow $27.00
SKID-TTOW. CONWT,DRUCTON AND PT,AN CHECK
$33-460
I.:ES;S PRE-PAt.;' I'a?TS
$0.po
NOW
$333.60
(\V•5t
)
� t'11\ `
ECEI
DATE
BY' ' "
D F
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
POOLS - SPAS
Steel
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
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fb(tures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
0
0
IPOOLAREAS
PLOT Of AKI.Kf ...,�
_ NO. FILTER NO. 3 270
ill
_NO.RETURNUNES 3
9S 1FT. FENCE
R *Wvpur :- jw HP I Y
-E&-ANTISYPHONYES
RICAL f --,o FT. BONDING YES
�LFT.TILE4COPINGNO. O&J"r WS
DATE PALM ENTERPRISES LOT
POOL/SPA CONSTRUCTION/LANDSCAPING TRACT
(760) 3.,98- 1766
CONTRACTOR NO. B -1;C -53;C-27 680775 SALESMAN PLAN NO.
SHALLOW ENO .....
❑
DEEP END D* ......
❑
P -TRAP ..........
❑
BACKWASH UNE ....
❑
FILL UNE .........
❑
GRADING .... ....
13
HEATER�) r10 f t ..
J9
GUNTTE INSP .......
❑
BOARD ..........
❑
....�..O
LIGHT W SPA ... ❑
SPA ........❑
C_ _ORINATOR
ROPE RINGS ... ❑
MAW. KIT ..... ❑
OTHER ....... ❑
OWNER 9/41
JOBADDRESS
CITY 40 MAP ND:
JOB PHONE%% � BUS PWONE
JQB N0: