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0006-402 (RPL)Ui « 04 W „ O =) M CY u7 W rZR o Z O� CSD I — J(-) CD Dk ~a Z M IO N ON Q CLZ L0 Q 0 LL X Lu — m U U O MLO Z_ co 5 �O Q J �Fl LICENSED CONTRACTOR DEC ''ARATION I hereby affirm under penalty of perjury that I am licensed under provisions.of Chapter *Commencing•with Section 7000) of.Division 31of the Business and Professionals Code, and my License is in full force and/effect. License # Lic. Class Exp Date C-53 �%'f 04/30/7.1 %;, ,Date„ Signature of Contractord• OWNER-BUILDER°bECLARATION I 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 • MEMPT Policy No. (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 thai if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisiorls/ Z 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 ,representatives of this City to enter upon the above-mentioned property for,inspection purposes. Signature (Owner/Ageit)("��!'Gt'&Date`'i✓ BUILDING PERMIT PERMI0 �' 4 W. DA VALUATIONS15'(W.00LOT TRACT JOB SITE- ,FO` i•<-.-.,..., ADDRESS (:i ilJFi OOW APN - OWNER CONTRACTOR/DESIGNER/ENGINEER 1y1/1v7. WIMLI:,EK, VAUEY P001.. & SPA 78.616 CABIJI,L0 WAY 4741 C; E. PALM CANYON V& #116 'L AQ�iRlil� CA 9225,3 PALMhP22i�iOS CA 92264 (760)778••3939 CB1.4 2565 USE OF PERMIT 1:'1001, A> ..)/GR S;PA POOL R: w. A, &BBQ(ANSIA )•ALElRMSIB.AMER SHALI.ftfflt4 NL.AC:9L Al PREPLASTER rNSPECTIORPOOL FOUIP RHMP,911RE IS NOT TIdCLUDE:D SN THIS P RMIT POO): ANDIOR SPA U%060M I's PRS l.' FES' SrTM0+II"Y FLAN CHECK 111tR 1Cil 000.4�9�31g $IOS,3D CCaNSTRUCT'IUN NEE: 111-000.41Cv-000 X167.40 WC HANICAL F'F.3? -- POOL 101-000,421.000 $24.00 ELECTRICAL E'EB .- POOL 101-000-420-000 $45,00 PLUMBING RE -- POOL 101.000-419.000 $27,00 1 � MB-'I'MAL C0.90'MUCTIOM AND IYLA1:7 Ci3lst'7< $1-63.30 IX S43 M,-PASY'Ti Z $0,00 'I'O'I'dl<.T.'YMOMYU,9DUR N'C1W "63.30 RECEIPT DATE DAT F NALov � INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS '• ' i MECHANICAL APPROVALS Set Backs Underground Ducts j Forms & Footings Ducts I Slab Grade Return Air I Steel Combustion Air Roof Deck Exhaust Fans ' O.K to Wrap F.A.U. Framing Compressor I Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls j Party Wall Insulation Condensate Lines I Party Wall Firewall I Exterior Lath I Drywall - Int. Lath I 1 Final Final BLOCKWALL APPROVALS steel POOLS - SPAS aU Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric (j Underground Plbg. Test - _ W Final Gas Piping �Gu 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: JUL-01-00 01:51 PM NHF CASTORENA 760 772 5860 P.09 r rtu' i L HL 1 r URIV 1 M r-p.A-a HVL ,r•MJ r PIL"t NU. r bM )`400 V r • a, ..� , .... .. _ 1 , , CITY OF- ---- N�Dt BUILDING SAFIYDEp 031R03p� � :�V011�� _ _ ._ �o P ROVES---.... aNd ....... N010N 3 © alts 'F CONSTRUCTION 03AOdddy 3H1 � -. J , k CIE. .L:. lvr IY\ `• � V lie. SHMMUMN 6REATE11001t . r FT um"W) W12,