9805-144 (CP)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.
Licenst # Lic. Class Exp. Date
r U5G12 C5-3 IV /98
g
Date Signature of Contractor _
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury4hat I am exempt from the Contractor's
License Law for the following reason:
—(.-) - I, as owner of the property, Wr� iy employees with wades -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).
O 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 Policy No.
(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 if I should become
subject to the workers' compensation provislons.of Section 3700 of the Labor
.E. de, I shall forthwith comply with those provisions.
✓Date:+.�'l Applicant
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 pt
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 authorizerepresentatives of this City to enter on
the above:mentioned property for inspection purposes.
* 1.
Signature (Owner/Agent) 6e, • � Date !
'm
PERMIT # CONTROL #.
BUILDING PERMIT;,�,,� -
�q �g
DATE VALUATION D.7g0�1��i1 LOT G� QG� ` L/ TRACT 7871 p 1
( fi L.
JOB SITEADDRESS -.960 RANCHO LA, Qallle TA.1<DR. �
APN
OWNER
CONTRACTOR /DESIGNER/ ENGINEER
Di".. E.w.n'tbaw1;
C-IM;1.Viti31: NIU,, VMOLS, & SPAS
P.O. BOX 1116
74-7.5 KANt I3F7.t.V . irA
1,A f.)UlCA 97253
PALM 'DLS.€;.RT CA 9'2116 0
MA _355....
USE OF PERMIT
K5t•)L,
,t�t:#O�..i�i'l� t1�1�i1, .r�i.Ae�2v€Sft3ACCi21�lZ,� SIiA%.1., i3� G�4'ia'ititT!��sE�i'..C✓EtiWi2.• - ,
TO .'PRE-PLA�� 1fitt )MSP?3i:.'€ OYN
>7L ANT) OR SPA 15,000.00 :LS
.CSTIV ED COST OF t.:OlNM.in.t.IICTION.
:1.3,0000
PERMIT SUMMARV
IYLA 14 Cf (E.CKFEE1.111-i1f 31 �€ i 3 j b $ P.US; ii)
Mr.CHAINi ALl`Fi:--POOL 101.000-421-400 ��313a3
13-K" RICl1L f'�1 ' •,- POOL If1: -* 04.n..0oo 34.tai±
PLILRVIDING 1 1M d POOL 101-000-41.9-000
t
• a•
AND Pi, j,4 CHECK,
- I.,LSS 1'�3?\�-•1?A3,.� "�+ls�"�
PA I
� �,l.Qi� .
JUN 0 5 1998 'acs°1'tai;, p���:tm�rf f?,:Fs Du1>•,t,40 �v
$3613.30
iTY 0 LA QUiNTA
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel >�
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
-
Underground Electric Id
Underground Plbg. Test ra
Final 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 —2 a
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
t
Final
Utility Notice (Perm)
COMMENTS:
LICENSED CONTRACTOR DECLARATION
I Pelby 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
636128 C53
Date <. ?l Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am 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 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.
(X) 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 Policy No.
t
(This section need not be completed if the permi��aluation 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%nd agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with��e proNsio_Os.
Date: W'S� n,�Applicant
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.
BPERMIT# CONTROL#
BUILDING PERMIT
4�!# 5: 1X14•
DATE !^^ VALUATION LOT TRACT 7 A 2 2
r ® L
ADDRESS 79-960 RA�+it;:HO LA 1�iT�.t�TA OR JOB APN
OWNER
,,CONTRACTOR / DESIGNER /ENGINEER
l..().!,sr.4AfrF4RIA PL3 & Sy
AS
79.295 :ItANCt 10 i.,f1. QUI'N TA DR 74-125 JONI Lilt€VE,1/.Fi.
i,,At;UIN! A CA 9225:3 PA;f,,i19.:971 Slsl:Cf CA 92260
f7tr(byi!)-goon 4 BT/E 355
USE OF PERMIT
POOL
POOL lS..PAilsB
POOL t+,ND,'0ii ilial. 0,000.00 LS MAY 2.9 1998
`j"19i1IMP`L 'O'S ie 0- fF
:flflk riff PER, S€3NIALaRY
!'J:.h'N CHFCK F.a I01-000-439-318 $itaS.3ti
,.trQ!':VXFCAI,At.r..-POOL i0; -MO -X21-000
Ii1V'(.:1`R iCAi, i ffd --14301. 161-000420-000
11LON4141ivc1 Wills -- Pt. 01. 101 -WO -41 �-000 �2,P.fiti
I certify that I have read this applicatrWand state that the above information- is
correct. I agree to comply with all/Gity, and State laws relating to the building
construction, and hereby author a representatives of this City to enter upon
the/above-mentioned property inspectio�urposes.
RECEIPT
;/Signature (Owner/AgerDt) fDate y,�X �%,
LESS PlUe-PIUDIFEES $004
DATE I BY / - - I DATE FINALED I 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 Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
TZ
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
_ 2
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)
COMMENTS: