0305-138 (RPL)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 Bus0ess`and
Professionals Code, and my License is in full force and effect -
License # Lic. Class '� . Exp. Date
Date ti ?ry Signature of Contractor����
' OWNER -BUILDER DECLAATION�
I hereby affirm under penalty of perjury that I am Lempt 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 `a'7:� P Pi71dU Policy No. t44i�3a•�a
(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, andel agree that if I should become
subject to the workers' compensation prov si6ns of Section 3700 of the Labor
Code; 11 h °II fo hwith comply with those visions.
te: �' tlElApplicant
Warning: Failure to secure Workers' Compensation overage is unlawful and
shall subject an employer to criminal penalties a'*qd 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., agree to comply witht�,City, and State laws relating to the building
C and hereby auutthorize representatives of this City to enter upon
44he above-mentioned property for Inspection purposes.
Signature (Owner/Agent) 1 j 1 Date
BUILDING PERMIT PERMT"
DATE f / VALUATION LOT' 41 +_'138 TRACT
M
4
� '/ ( "-�•� 57161.4;,% •. ° r +, `
JOB SITE
APN
ADDRESS 494615 RNCi{, O ,5AN FRAN0,SQWTTO
-
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MR. ADD/Ok MRS. COUINS
T+itWL Y .:POOLO COMISTRUCTION
44a�JE� t'1►L �AN'Ia�P,AR ATtA
53300 A'q?A,i2NMIRM
LA (I)LA1TP. OA '922530
U. f,?•t13'cJ`M CA, 92253
?�U)5��9�3t3a"3 Mib. 21393
USE OF PERMIT
PWL AM/OR MIA
POOII. SPA, BBQ_(Arltil 7,11443-1995). 10 f. F': 31131XICK WALL, C'1'1'Y
STANDARD, ALARiVSIDAIRRIERS Sti11LL BE 11; PLACE A1° 1TdL�,•1'LA�3i'ER,
1W'S''f: TION
i Fr. WALL. 10.06 L
'POOL, ANDICIP. SPA iS
+�U
Nv°✓TIMA..1.7-3 ..OST 03+' C0AVtR''V `,rt0N
PIw i1T 611 s) `�Ry '
PLAN CHECK FEE 101 -000-4 39- 18 $111.16
COINS't`RUCTION M 101-000-418-400 $171,00
MECHANIC RE -- POOL 101-000-421.000 $24,00
FILE€;`i'RICA1, Pitt a- P001, 109-000-420.000 X5.60
PLUMBINO FEE • F001; 101.600419-000 07100 '
S TOTAL �'pA3:iT�Z'UG�f ON Pa...1� P C -It�..,�IC
$37 8,15
:. . 5 PRE•PAYD 1M
20.00
TOTAL I-12RAW FEES DUN 14OW
MAY 29 263
OfLA GUINTA
CITY
RECEIPT ' E : •
BY C,;,
QATE.QNALED
INSPECTO
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 Y
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping -
PLUMBING APPROVALS
Gas Test i
Electric Final
Waste Unes
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
Lir Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:.-
OMMENTS:-Final
000
Construction
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
BY
Warden tlore
49-69Pancbo-'5an rrarri--;quilo
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