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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
--Professionals Code, andmy License is in full force and effect.
License # Lie. Class Exp. Date
2/28/04
Date Signature of Contractor. � f
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors
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 ZIA,,r Policy No. "9-9671-203
(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 fo'the workers' compensation provisions of Section 3700 of the Labor
Code, I sha11/fortli6th comply with those.jirovi§ions. ,, „ ! •� ;
Date: Applicant—
Warning:
pplicant 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 Lab&r 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.
41
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 propertykfor inspection purposes.
Signature (Owner/Agent) t Date`' f
/BUILDING PERMIT PERMIT#
L& TRACT
DATE t '`' j VALUATION Do -
GG ,r�3� ..:
JOB SITE
ADDRESS «�:X801�V.�n.+t�+OABEVI RID S
APN -
OWNER
CONTRACTOR/DESIGNER/EN (NEER
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193 C.:li,6 LY DE A`E�i-, OLitS
78-120 CALIX =ADO SUCIS =W
L13.2'UWTr_& CA 02253
I.JS.QT.I:WrA CA. 92253
(1t�5firo1R6 C('I�9 S59
USE OF PERMIT
POM J%ITD/QR EPA,
P001ASPA, .A1AM3MA RM1FJZSf 1HALL 1!a' IN 1'.LACE JVr lEyI`ZMASTERZ
P006VtWC;P.9PA 1110:0.00 US
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MECiii.Fi' UCAL RA -• POOL, 101-000-421-000 = 424.0713
LLF.r,TR1C;W.P%*F. . POOL 101.000-420•000
rLVIO,98Ic O FEE `POOL 101-000.419-1300
will,
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MAR 03 2003TA
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RECEIPT
DATE/e" '��
BY(�4M �
DATE FINALED
INSPECTOR.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
L —_ _
/�!1
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
/
,41
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
Sealer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
/
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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)
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53-865 AVENIDA BERMUDAS
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CITY OF LA QUI
BUILDING & SAFETY
APPROVEI
FOR GONSTRUCR
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UNAUTHORIZED USE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENGH DES ON
GROUP. REPRODUCTION
IN M WIEN
ANY FORM WRITTEN CONST
IS EXPRESSLY PROHIBITED. UNAU lH0RIZED
USE EXTENDS TO ORIGINAL AND MODIRED
DERIVATIVE PLANS AND IS APPLICABLE TO
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INFRINGEMENTS.
DRAW)
T.B.
CHECKED
S.L.
DATE
02-18-03
SCALE
1/8"=V-0"
SHEET
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EQUIPME
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DURANGO
ESPECIAL 10
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CENTER OF LOT c@ AVENIDA BERMUDAS
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CITY OF LA QUI
BUILDING & SAFETY
APPROVEI
FOR GONSTRUCR
1-11
DA 3�3 9 ex. ,--
UNAUTHORIZED USE WARNING
THESE DESIGNS ARE THE PROPERTY OF
LENGH DES ON
GROUP. REPRODUCTION
IN M WIEN
ANY FORM WRITTEN CONST
IS EXPRESSLY PROHIBITED. UNAU lH0RIZED
USE EXTENDS TO ORIGINAL AND MODIRED
DERIVATIVE PLANS AND IS APPLICABLE TO
INTENTIONAL AND UNINTENTIONAL
INFRINGEMENTS.
DRAW)
T.B.
CHECKED
S.L.
DATE
02-18-03
SCALE
1/8"=V-0"
SHEET
#2
PLAINS PREPARED BY:
LENIDEL VE\TGRES, IAC.
dha
LENCH DESIGN GROUP
A.P. LENCR R
PRESIDEnT