0302-016 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisioiis
Chapter 9 (commencing with Section 7000) of Division 3 of the Business ai
Professionals Code, and my License is in full force and effect.
License# Lic. Class Exp. Date.,-*,
614611 C53
Date% Signature of Contractor P ��"`
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contracto
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sc
compensation, will do the work, and the structure is not intended or offered 1
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licens
contractors to construct the project (Sec. 7044, Business & ProfessionE
Code). {t/"
O I am exempt under Section B&P.C. forithis reason
Date .�� ' �� - Signature of Owner
w ..
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaratior
( ) I have and will maintain a certificate of consent to self -insure for worke
compensation, as provided for by Section 3700 of the Labor Code, for tl
performance of the work for which this permit is issued. '
( ) . I have and will maintain workers' compensation insurance, as required
Section 3700 of the Labor Code, for the performance of the work for which tt
permit is issued. My workers' compensation insurance carrier & policy no. al
Carrier ST.r TE RiY)r D Policy No. 046.02 010401
(This section need not be completed if the permit valuation is for $100.00 or les
( ) I certify that in the performance of the work for which this permit is issue
I shall not employ any person in any manner so as to become subject to tl
workers' compensation laws of California, and agree that if I shouldhibecon
subject to the workers' compensation'Provisionsof Section 3700 of t6e Lab
Code, I, shall forthwith comply with those provisions. (
rDate::J r —4Y 4 Applicant F7 1;(^ ".7,
t ,, L
Warning: Failure to secure Workers' Compensation coverage is unlawful al
shall subject an employer to criminal penalties and civil fines up to $100,000,
addition to the cost of compensation, damages as provided for.in Section 371
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safe
for a permit subject to the conditions and restrictions set forth on t
,,application.
1. Each person upon whose behalf this application is made & each person
whose request and for whose benefit work is performed under or pursuant
any permit issued as a result of this applicaton agrees to, & shall, indemn
& hold harmless the City of La Quinta, its officers, agents and employee
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatie
I certify that I have read this application and state that the above information
correct. I agree to comply with all City, and State laws relating to the buildil
construction, and hereby authorize representatives1dfVhis City to enter up(
the above-mentioned propertyr or inspection purpcises )
Signature (Owner/Agent)^'Date �`S
��'" ..BUILDING PERMIT PERMIT#1.
ig
of =
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DATE J/ _ ! VALUATION? LOT TRACT
JOB SITE
ADDRESS 7400 RAMC HO SAR t'A,Sl"`$fA L APN _ r
i
OWNER CONTRACTOR / DESIGNER / EN 1NEER
LA C, UNTA CSA 92253 LA ( jIJINTA. CA 322x:3
de ML4 1945
or
USE OF PERMIT
POOL 4VIVOR MPA
ds
P0011$P.1 _ A4.A47NSfB_A. RiCi S SN,AIA, BF 114 Rf:. CIi AT PIM-P'LASTRUZ
WSPEC''TION, &QUI ME,H!' L't1'CWSURE N6T ENC"L,faDED
ie
Jy
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e:
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�) F].."L CHUwl FEE 101-C)C O.439a3 i s3
d, Ct;SAiW.t'r" UC,TIi3M PRO,' 1(S'!-Ctt`1C1df.i�<(},��Cj YId7.ft�
1e MRCr`.i�#AAdIVA- T. FEE POO 1133100.421.000 M.00
ie
or ,k:f w'T'TUcAll. VZO, __ :Pool, 101"000-420-0011) $43.00
PLUM'S1,00'F+'tt,:iK -- POOL 1101-000-419.- $%",00
id
)6 Ftb u 2003
ty CITY OF l,.A QUINTA
is �INs�dCE DEPT.
at S4 _ SUB- ?CYx'AL CvC'NMTZt]'M`,IKON A%l31'A.,AW IRO $163.30'
to
fy IMS PREXPAMMMS $0, 00
S.
if '4'C7:1.'A113_1 .R°.0 IMES DWI, .114 ow, & `b.30
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RECEIPT DAT{ /� BY�^'«� DATE FINALED INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
r
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
f
Underground Plbg. Test
^ ,
Final
Gas Piping
s
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)
41 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 (Perna
COMMENTS:
+18" WITH CONCRETE
CAP AND STACKED O coy'
STONE SPILLWAY. CITY OF LA Q NTA
PEBBLE FINISH. BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUC N
I
1 DATE 03 gy
• %` i`a BOULDERS
I A RE—INSPECTION FEE OF $30
WILL BE IF THE
.- •.. ' PLANS ANDAGED JROB CARE A EPPROVED NOT ON
SHE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS! .
I SUN[
P LE _3, .
FINI
ENTRY
STEPS ,
CANTILEVER �•'
COPING
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EIRNS
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TRCo.
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TAL I
TANTE LET 44
-7q � -o
laoumCha Sam S( POOL I
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0��✓1k C'4' EQUIP.,
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