9904-163 (RPL)1.
„ , -;,I : LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I. am licensed under provisions of
I•_ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CN W Professionals Code, and my License is in full force and effect. _
O ch License # Lic. Class Exp. Date
O 6.56128 C53 10/31/60
OZ ate �� %� Signature of Contractor
J U � OWNER -BUILDER DECLARATION
H.Wd r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CD 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
C)_N Date Signature of Owner
rn
U Q WORKER'S COMPENSATION DECLARATION
j < Z cc I hereby affirm under penalty of perjury one of the following declarations:
F, p () 1 have and will maintain a certificate of consent to self -insure for workers'
K W
ILL compensation; as provided for by Section 3700 of the Labor Code, for the
D � Q
Qperformance of the work for which this permit is issued.
Ell;U U I have and will maintain workers' compensation insurance, as required by
j,V, ' Section 3700 of the Labor Code, for the performance of the work for which this
i H permit is issued. My workers' compensation insurance carrier & policy no. are:
`t Z Carrier Policy No.
aD �D•y b �'A111 JiJ►� s> �t�•a”-(;3�`tfii5o
I-,.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 leAuld become
t subject to the workers' compensation provisions of Section 700 of the Labor
Code, I shall forthwith comply with those provisions..
Date:/
•�/-Applicant77T�-s•
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. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representativesof this City to enter upon
/the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date i
BUILDING PERMIT PERMIT#
911iki- !63
DATE 4/19199 VALUATION S22,%M.()0 LOT TRACT
JOB SITE ADDRESS 79-1`141 is e'�EjrELE; B RiSS�1
APN
r
OWNER
CONTRACTOR / DESIGNER / ENGINEER
T.D. DESERT I?LV1»l,,O:P'v;i ITT
C.ALIFORNIPCX)I.:+ & SPAS
P,0. BOX 1716
74-725 .CONI DRIVE, #A.
LA.11U1iaTA CA. 92253
PALM DESERT CA 02260
1.760)340-9000 MY 355
USE OF PERMIT
POOL AN1) OR SPA.
P001iS`l'.Ej►F Nt Q - Ai..All MS113ARX—'WR8 WSi' B tN i LACK AT
llltli-l�LA,S'!7?lt dN5l�N.�:;f'tt:;+tu.
22.90r.00 1:,8
)'t,IMIT FEE, SUMMARY
PLAN OflEC;K FEE 111.0(141 -439 -.;.IM $,152.10
Rpr+�a'tf.)N t�?a 101dyiyy -41 Ei-t�0) 5234,00
1t�_�(1N�7Srf' ,�rr'�k t
`aia .511 NUCA1. f'j ,--I*C9)1, ,1611.-0(i!)-421-000 $^•1.00
E.0;ZI't ICAL I -.fps' ., taGn A. 101-000-420.000
VILUNIBING 1"H __ POOL 101-410"19-000 �'.►r.c�a
8119 Rli'A1,Cf. Nt isIV1JC110NJ AN17 V,ItAN CIIE.0 K
$492 In
1,U" PRE -PAID FEES
$0,00
TOTAL PERMIT Je CKS 0UK NO
$48L10
RECEIPT
DATE
B,V
DATE
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
OX 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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
- I
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
- L
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
.. G
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: