9903-014 (RPL)�m
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, and my License is in full force and effect.
License # Lic. Class Exp. Date
5,.19747, C-53
Date �7 Signature of Contractor -�� f, ✓�
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
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 Policy No.
S't'r`f I, I Us+fll 1034W-1-,93
(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
Code, I s all forthwith comply with those provisions.
ate: fi % Applicant 4/4"W A'k ; l r"
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. l 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 property fo` inspection purposes.
. - , '
S(Owner/Agent)�✓��''+//// 'Date �� f'
BUILDING PERMIT PERMIT#
DATE VALUATION1'd�Q� LOT TRACT
JOB SITE
ADDRESS 79-705 CAl!'f[1a O 110S.ADA
APN M -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MIKE & SARM i:`l:URAN
AIMMICAN POOL, C GINITI RUC'T 100
79-205 CAMINO ROSADA
73w9'G() HIGHWAY L I I
LAQUM.Yk CA 97M53
.YALAI L)ESEM' CA 9VVS5-19
(76(l)-200-2599, (",L%r.if 1104
USE OF PERMIT
PCA,)L f WDiOR SPA
P100LISPA, AL A9AiS10AJ3iti) ZS S14Ai.L FIE IN AT P:i< rLA ITR
Ii+f51�1~t;1'.ICaN, EQUIP. SC'ttlXN WAIL
POOL ANDVOR.4SPA, 17,M,00 ,00 LS
f1,,1,ff;1A1AT2`,P0 COST OF CONSTRUCT ION
J1117,0140.00
PLAN CHECK fTZ 11,1-U(?t� 43�»ryl ti $ i 17.ib)
C, ONv M7,11T f/y«.v�'� TE 11 Rd�)/(�i) 1 Wi,
y01-(HSA1
•C�tt1l
ppa_C'���;yN���� y�17
NIEC�1_�J.tWfAi.La .�',f:L_^Jtj.oa ti71- .421-O1�11
HLEC'rWCAI, FW - POCA. 1.01 -M -4170 -OW $45.04)
;
LUMBINtL FEE— POOL, 101-000-419-000 S27.00
✓
'S'08 DTAL C:C},f`fKrO.i.C.i.'TON AND PI ANN C,HFCK
$343,003 ? .
LESS PRE-PAWTS
$000
TOTAL PERNOT FEV,$.DVR NOW
$393.00
RECEIPT
DATE
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
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.
Smoke Detectors
Temp. Use of Power .
'Final
Utility Notice (Perm)
COMMENTS:
-
:T�
T
CITY C.)? A QUI N' A
BUILDING &SAri"ETY DEPARTMENT
CONDITIONALLY
ACCdPTED FOR CONSTRUCtION
I
SUBJECT TO INSTALLATION AS PER
A D ALL APPLICABLE CODES!
c
7Cg By
7`11r,
cc C-
\' I 1
ii
PROPERTY LINE OU UTILITY POLE Q auN-TK)N BOX @ FIDSE BIB SKMMER
UTILITY EASEMENT OE ELEC. PANEL BLDWER ---- FILL LI1� 4 LC+fT
FENCE (HEIGHT, TYPE) 6a
41 -As
GAS ET&T
ER �,(DVATER- LEVELER (D' FILTER
— L
'44 "BENOHNARK
a
. . . . . . . . . TV�W�arrcLVE Jjj iNES"
L
RA
I
r 4%4o
DECKS -DRAN
AREA DRAIN 1 3y2
PVC- DRAINQZRA
wi: •
-,:4-140T
-E
ra -p.-- .41
�PA L'X
0 3
.0
f v, c: r -H ir-- ti ce, c-,)-., * c:cyr.., /r w1i u,
Noief
Lolp Vl^ I Vi�'— @ 15&
A
ARal-\ M.AP
c- � � P NO
A
Y/Vcp
!111 c 4-2
MMACT
OPFCF---
NAME_
ADDR (I iC.
LOT BLOCK SEC
..TELE 360 W TELE. -ji!Z-
AAWLICAIN
cc C-
\' I 1
ii
PROPERTY LINE OU UTILITY POLE Q auN-TK)N BOX @ FIDSE BIB SKMMER
UTILITY EASEMENT OE ELEC. PANEL BLDWER ---- FILL LI1� 4 LC+fT
FENCE (HEIGHT, TYPE) 6a
41 -As
GAS ET&T
ER �,(DVATER- LEVELER (D' FILTER
— L
'44 "BENOHNARK
a
. . . . . . . . . TV�W�arrcLVE Jjj iNES"
L
RA
I
r 4%4o
DECKS -DRAN
AREA DRAIN 1 3y2
PVC- DRAINQZRA
wi: •
-,:4-140T
-E
ra -p.-- .41
�PA L'X
0 3
.0
f v, c: r -H ir-- ti ce, c-,)-., * c:cyr.., /r w1i u,
Noief
Lolp Vl^ I Vi�'— @ 15&
A
ARal-\ M.AP
c- � � P NO
A
Y/Vcp
!111 c 4-2
MMACT
OPFCF---
NAME_
ADDR (I iC.
LOT BLOCK SEC
..TELE 360 W TELE. -ji!Z-
AAWLICAIN