0102-232 (RPL)�T �^ LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
„W..1, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CV W Professionals Code, and my License is in full force and effect.
=) ch License # Lic. Class Exp. Date
Cy
LLJ
690645
Z t- Date �Z " d 0 f Signature of Contractoof P -'" � _ -
O
CD
_JU OWNER -BUILDER DE LARATION
H LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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
a Date' Signature of Owner
v0' 1c\1*_
CL Q WORKER'S COMPENSATION DECLARATION
C:) CC I hereby affirm under penalty of perjury one of the following declarations:
- p () 1 have and will maintain a certificate of consent to self insure for workers'
X W !!: compensation, as provided for by Section 3700 of the Labor Code, for the
OJ Q performance of the work for which this permit is issued.
ro
Q () •� f) 1 have and will maintain workers' compensation insurance, as required by
p U Q Section 3700 of the Labor Code, for the performance of the work for which,this
(1: LO Z permit is issued. My workers' compensation insurance carrier & policy no. are:
r O Carrier OWE FOND Policy No. k 946. 0
J (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply witD hose provi Iris' �'rA
Date: -"'` _ t Applicar ter... " .
' S
Warning: Failure to secure W ers' 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 SafeW%n
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
u �A; whose request and for whosesb'enefit 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•,L' i 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 props y for inspection purposes.
Signature (Owner/Agent/" ° W-- Date_",•_
BUILDING PERMIT PERMIT#
DATE " ` / VALUATION LOT 0192-232 TRACT
r ( '<3,4 d3Sb 1 23389.4
JOB SIT
ADDRESS
APN
X904 SWECKENIU
OWNER
CONTRACTOR/ DESIGNER/ EN IIN/EER
] ��qyp A5 Y
RM" Tic"114 114 LLC
Mi. 19 Y ..x: N,.FL•;� M. % 1 8, �i.K(';.
410
1425 1& URAV MY lt?E2M
LAQ•(.U"3,RM. CA 92233
PROMIX Ate. 85034
(602)237-1656 MIR 4990
USE OF PERMIT
POOL SHALL BE IN PLACE AT F"
1114MTER, HHHPFX,Ti+'YK i0C✓`k„EiWIPM.ENT ENC'WHURP, tis 140'1"iFdQ;IAID D
PATHOS PEP AI
Pool, AR4WORORA 1%W.00 LV
ESUMAXED Cowl" 0F CONSMOC11110N,
PERM 11 M SUAIKWY
PLAN CHWX .FEF SWIM
4r ON'S''i'k1YJi"'1'JOW tZF 101-000-418 000 $111.00
WCi•.1t#4NICAL FR - POOL, 101-000-421-000 $24.00
ELF,CTR1CA1.PWL M-0,111-420-000 $4.1tllb
tt
PLUMBINQ F% .. �-1'O0101-000=419-NO $VZOP
1
MAR 05 2001 ---
YViPLA UU01
011x-7VYAL C ClMSMIXICTION AM PLAN �"l�:C�;L ;"
$2019.05
t ai p�?.1•l-RAID NI t'
$0,00.
REC I .
DAtiE rri�
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
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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 Pale
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures-
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
6-1
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE
RYOt/
Ii
CD
�s
10
0.5% M -N.
- %.i -. -.-
C)
.-
A RE -INSPECTION FEE OF $3u
ARGED IF THE APPROVED
PLANS A D JOB CARD ARE NOT ON
THE i. SI E FOR A SCHEDULED
INSPECT ON.
NO EXCEPTIONS!