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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 ag effect.
License # Lic. Class Exp. Date
E16ate •� Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(This section need not be completed if the permit valuation s�or$100'00 or less).
( ) I certify that in the performance of the wore 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 shall.forthwith comply with those�provisions
Date : / ` / Applicant'' .
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 a11,"C ity and State laws relating to the building
construction, and hereby authorlie�representatives of this City to enter upon
the above-mentioned propertyfor Inspection purposes.
l
Sjgnatu�e (Owner/Agent Date
/ BUILDING PERMIT PERMT# . CONTROL#
DATE t VALUATION LOT 9SO4_JS.0 TRACT 7099
JOB SITE APN
ADDRESS
'79-870 CARRHJ,0
OWNER CONTRACTOR/DESIGNER/ENGINEER
T.D..DESERT DEVEL OP vLEN1'
P.O. BOX 1716
L?•, QIANTA CA 92253
USE OF PERMIT
CAL.1F0R' i1LA. PUOi,F, cC 4A.S
74.725 JONI DRIVE, #A
PALM DESERT CA 92.260
(76Q)3440-.9000 C1 LM 355
POOLISPA,1311Q ONLY, ALAPA4S/LARR1URS ARE TO 139 OPERA TI IONU- L ;
PRIOR TO EN -CAP, PRF,.PI,ASMR INSPECTION
POOL ANl7,Oit SPA 15,000-00 L3 AOR 2 7 1998
"I`fY OF LA QUINU
ESTIMATED COST OF CONSTRUCTION ION 15,114191.4141
PERMIT TEE SUMMARY
PLAN CHEt' `FEE 101-000 439-31€3 $105.30
CONSTRu'C'rION FEE 101-000-11.5-000 S162.00
MECHANICAL FEE -- POOL 101-000-421-000 $24.06
ELEC'nk]CAL FEE -- POOL 101-000-420-000 $445.00
PLUMBING F M. - POOL 101-000-41, 9-000 $27.0+0
SUI-'fff'aA,. CO,NSTP.UC77"ON AND ,PIAN C14E,CK $363.30
LESS :PKE-PAID FEES $0.1011
TOTAL .PERMIT FEES DUE NOW $36.3,30
RECEIPT DATE BY(, J DS ZN/1 7 q � I 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
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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 Deteptors
Temp. Use of Power
I
Final
Utility Notice (Perm)
COMMENTS: