9605-097 (RPL)U)
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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 and effect. ,
License # Lic. Class .Exp. Date
&50-i23 C53
46
Date Signature of Contractors 4 Lj
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I aryl 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 withilicensed
contractors to construct the project (Sec. 7044, Business & "Professionals
Code). j 7
( ) I am exempt under Section , B&P.C. for this reason, /
Date Signature of Owner 141111i t %r' JA,�; _. y
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.
( ) 1 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 isa ss, c M�lwprkers' compensation insurance carri�y&,policy, no.'are:
Cartier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
f�
() I certify that in the performance o'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 agreei 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: :I
Date: Applicant /1 `t ` t u
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 iso
correct. I agree to comply with all City, and State laws relating to the building'
and
r .: 1 i
construction, and hereby authorzetrepresen tatives of this City to enter upon
the above-mentioned property forinspection purposesliff
,
Signature (Owner%Agent) Date
BUILDING PERMIT PERMIT# CONTROL#
96054")7 3351
DATE �f �` VALUATION LOT TRACT
JOB SITEI APN
ADDRESS 49-•585 CAJIA:)•f1t�ANO WAY
OWNER
S f`E1'iXEN
48-5115 CAPA.9.1V ANO WAY
LA QtJINI A Cf1. 92253
USE OF PERMIT
POOLANWOR SP
1406A., AKOX)R. SPA
CONTRACTOR/DESIGNER/ENGINEER
CALIFORNIA POOL., & SPAS
414jtO BiDA13.. AVAIX #A2
PAI,Rd. DESF'Wr CA 92200
(619040-'_�iJi)0 CB1,11 35
iS,ot1 w I'S
E'STEUX11"'Ci 1) COST OFCONSTRUCTION
PLAN VUECK OR It1 E-attl�-13`1-31�t �1�S 3fl
C0N:,'TMLr fIf,;)NPEF 101 -000419 -OW �162:W
iNiSCIIAPJs'.(::AL ETr POOL .$24.00
1:t ,'C 1RIC'AL 14,%,-.:k"f)OL 101.0W -a20 -t' 00 $45,00
P4;!Afl3fNCi 1qT. —.N00t 101.0(Y)-4I9.0U0 VAT M
MAY r 0 .1996
I
CoN.sT w(v*n6N 1�ND PLAN CH ECK
CESS PRS:-1)Ai_Ii FEES
TOTAL PER NOT FEES :1)ItI+, NOW
to •
RECEIPT DATE BY, i� DATE FINALED JINSPECTOR
�3r;3,3{1
WOO
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
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final I I
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:
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.
i<,.noke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)