9802-011 (RPL)~ ' '
LICENSED CONTRACTOR DECLARATION .
| hereby affirm under. penalty o/perjury that | am licensed under provisions 6f
Chapter 9 (cbmmencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Lic. Class Exp. Date F.-
r5l 1/30/99
IE(I te r+ A A7) Signature Of Contractor
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
() |, ao.owno,ovthe property, or my employeeswith wages aotheir, sole
compensation, will do the work, and the structure isnot intended moffered for
Sale (soo.ro44.Business mpmfeooiona|oouue). .
( ) .|. as owner of the property, am exclusively gontracting with |iconoed
contractors to construct the project (Sec., 7044, 8uom000 �& P '
Cooe- .
(> |amexempt under SounvnomPC for this re000n_______
bate* of Owner
WORKER'S'COMPENSATONDECLARATbN'''
| hereby oMinn under penalty of perjury "one of moJo|imwing declarations:
()| have and will maintain acertificate ofconsent mself-insure for workers'
oompenoation, as provided. for Uy G0000n 3700 of the Labor Code, |h,too
performance of the work for which this permit ioissued.
( ) | have and will maintain workers' compensation insurance, aorequired W
Section 3700 of the Labor Code, for the performance of the work for which this
ponnn is issued. My workers' compensation insurance carrier &ponoynuum:
Cyh� Policy No.
. '
8TATEFUND 1,344032,97
(This section need ,���m���mo�m ����hx
( ) |oo���o in the performance of the work for which this permit ixissued,
| shall not employ any nor0000m become subject m'the
workers' compensation laws o/California, d that if | shouldbon
subject to the workers' compensation -vi ko-n�s_f Section 3700 of the Eabor
s,,;e
c ode Is 11-f rt With comply with tho i��Rvisiono
./Date: Applicant-
Warning- Failure to secure Workers' Compensation coverage is Lin lawful and
shall subject an employe�r to criminal 'Penalties and civil fines up to �ibo,000, in
addition to the cost of compensation, damages as provided for in Section 3�66
of, the Labor Code, interest and attorney's fees.
IMPORTANT Application iohereby made tothe Director o/Building and Safety
to, u pnrmit oubjom to mo oondihono and ,opt,iodono out forth on xio
application.
1.Each person upon whose behalf this application ismade ueach person oo�
wm000mquomand for whose benefit work ioperformed under orpursuant m
any permit issued 000result of -this opp|iooxonagneoo.to. &ohaU. indemnify
& hold harmless the City ofLa. Ovinto. its officers, agents and employees.
2. Any permit issued as nogu|tof this application becomes null and"oid if
��
worki commenced within 1 d , d�eofi ofpermit, or cessation of work for 180 days will subject permit to canicellatid�.I certify that I have read this application and state that the above informaitiron"isprrect. I agree to comply with all City, and State . law s relating to the building,.o.,construction, and hereby authorize rSre.sentatives of this City to enter up�nthe above-mentioned property foHp0pection purposes./Signature (Owner/A�ent) Date -0 ki b9p
BUILDINGTERMIT
DATE VALUATION LOT 9802-011 TRACT
6559
JOB SITE
ADDRESS
7&M RANCUO LA QUINTA DR.
OWNER
CONTRACTOR DESIGNER / ENGINEER
79-900 RANCHO IA QUINTA DR-
53.V_0.KVF'91D.A. PLAMIREZ
LA QUR-4TA CA 92253
LA QUiNTA CA 92153
COU 2&93
USE OF PERMIT
POOL
36
POOL AND/OR SPA LS
PLAN CHWX FEE 101 -000-4" 39�318 S116180
COMM= [ON FFX- 101-000-418-000 $252.00
NMCKANICAL FEE -.-P001, -101-000-421-000 $204.00
-TOTALCONS17RUCTIONAND PLAIN CHECK
TOTAL IT FFFS DITF, NOW
S511.80
RECEIPT ___[EDATC� BY;O 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 Plbg. Test
l
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
F'rdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: