0007-250 (RPL)LICENSED CONTRACTOR DECLARATION
r I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of4he Business and
04 W Professionals Code, and my License is in full force and effect. Y
O M License # Lic. Class ^' )Exp. Date
W /te�17;v
`B I -PIC A. �'" 06/30/2(
Z � ) D, Signature of Contractor.
� 0 v r 1
F- OWNER -BUILDER DECLARATION`
J ,
H a I hereby,affirm under penalty of perjury that I am exempt from the Contractor's
U) 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).
M () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
OC\J
CIL WORKER'S COMPENSATION DECLARATION
o 2 Z I hereby affirm under penalty of perjury one of the following declarations:
U-) F2Ir
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
C0 Q C) ( ) I have 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
0) Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier I�Ia. CoMp N),jy OF r Policy No. }tVDLr1?4f741.6A€
oro C)
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•iftl should become
3 sugject to the workers' compensation provisions of Section+3700 of the Labor
Code,1'shall forthwith comply with those•provls&ons;'
ate: �� ; Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject ari'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
1 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 repres' ne tives of this City to enter upon
the above-ment�ned property for inspection.purposes.
4
Si nature (Owner/Agent)
J JJ BUILDING PERMIT PERMITJ#��
D TE VALUATION LOT TRACT
�iO,QKkJ.fftb
JOB SITE
ADDRESS 50-440 C*11RE+SSPO J
APN
_
OWNER
CONTRACTOR/DESIGNER/EN &NEER
M WVEHMENTS, IiN'C,
RXr 19VEZT3vIMIS, INC.
1425L, UMVFRMTY UIRIVE
1425 Il. UMIMSTrY MWE
PHOF-WT (. AZ 85034
PROERN AZ 8SO34
(602)257^1656 CBI,## 4990
USE
EOFPERMIT
POO.4DVEWA
i
POOL &SPA ONLY-ALARMSABRJUERS SHALL 1,39 IN PLACE AT
VALUATION f` 101 00.00 LS
lKSTMAIND COST OF COMP2UC TION
10,000.00
,
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9" L1� CHECK. FEE 1 01 -000-439-31 �P 11 f 05
101-000-439-318
CONSTRUCTION PEP, 101-000-418-000
MECH"ICAI, FEE -- POOL 101-000-421-000 $24,00
KLECTRICAL ",E — POOL 109 :000-42C 000 $45.00
PLUMM43 ME --POOL 101(300.419.000 WOO
S
•'.
AUG 10 2000
LA QUIN'I'I'L
SUt3-TU^1,hi, CON_ 09 AND PI AW C•IR..CK
Z.�ia�f. S �I2.T+�*Y�� D �'! S
6'O.Ob
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AT FROKS WEB OW
u
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel- w
Set Backs
Electric Bond c�
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
COMMENTS:
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l
v U
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)
I
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CCWSTRuc-noN
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