0006-356 (RPL)LICENSED CONTRACTOR DECLARATION
C/)I hereby affirm under penalty,ofFperjury that I am licensed under provisions of
I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W ! Professionals Code, and my License is in full force and_ effect.
O M License--# Lic. Class ��-'`�Exp. Date-•^
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�'� 69064.5 13• � �' 30M
6 ZO � Date /1'�� /•} 'Signature of -Contractor
t` P: OWNER -BUILDER DECLARATION
W WcD
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ N 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). r
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C'`)() I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
CL
C) < cc I hereby affirm under penalty of perjury one of the following declarations:
r Fa-- O () 1 have and will maintain a certificate of consent to self -insure for workers'
X J J compensation, as provided for by Section 3700 of the Labor Code, for the
m_J Q perfo�a,� of the work for which this permit is issued.
Q () ( ve and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
H permit is issued. My workers' compensation insurance carrier & policy no. are:
zCarrier Policy No.
co 5 INQ OF THE 1 ? WFIA70041900
lr�a
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 manned so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' ll fcompensational v�¢io s of Section 3700 of the Labor
3 Code, I shaorthwith comply wit • hose provlsl�;,
Date: % _ %-% APPlicant-��„x.r4
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
fora 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 wor0or 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 authorii'e �epresendtives of this City to enter upon
the above-mentioned property for nspection'rpurposes.
Signature (Owner/Ag %fr Date
I / Y/
6b...j °O UILDING PERMIT PERMIT
VALUATION LOT TRACT
EaW76 3( MAMA) LOT
25389.3
JOB SITE
APN
ADDRESS 78-927 HMC .�. IDG.>. IMME
OWNER
CONTRACTOR/DESIGNER/ENGINEER
I'tJ"1:fNmnMEmis, INC.
R.TT INVESTMEIM, INC.
1.425 T& DNPM. MIT Dom?
1425 P 'UNl_NEP rY 7?R1VF,
PHOLUX AZ 85034
P110L= AZ 55034
(60.2)251-1656. =4 4990
USE OF PERMIT
POOL AMOR 9PA
SFIN LOT 49, PLAN Alt , PERMIT DOE' NOT INCLUDE RIAICK 'WALL OR `
POOL75% REDUCTION CTiON ON PIAN CHECK FEE FOR, MULTIPLE ISSUANCE
OIC SAIME PUtH TYPE,
POOL ANDIOR SPA 10,000,001.4
E913i1MIED COMT OF COWMW01014
1(D,0( 0.00
PU.N CHhCK ME 1.01.000.439.318 $7610
E._, �'FT
CONSTRUCTION ION PT -E 101-000-418-000 $1111.00
�
MECH”' IC.AL FEE --• P001, 101-000.421-000 $24,00
LtLECTRtCAI, PRE •, POOL. 101-0i 0-420-000 $45.00
e.• a _
PLUMBING IEEE - POOL 101.000.419-000 $27.00
t' - z j Vr
;
RM -TOTAL C010Ti�tiif;.`T7:CK AND PLM ME=
$289°0:5
L1'IN PRE PA03 rpzS
$0.00
r0FJ 4 L 1'1.i lN.rrFnS Di`W -NOW
"I a AN
a
RECEIPT
DATE
�6Y
DATE FINALED
INSPECTOR
1
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
Steel
POOLS - SPAS
Z- -r_
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
- - vlf12 21
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Temp.Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
X/
A RE -INSPECTION FEE Of 130
z WILL BE CHARGED IF THE APPROVED'
PLANS AND 10BCARO ARE NOT Oft
SCHEDULED
IHE SITE FORA
{INSPECTION.
.NO MEPTIONSI
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CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATEr.J - pY ��"'�
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