9808-015 (RPL)LICENSED CONTRACTOR DECLARATION
1'Fereby-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
A/ate ` 17 t� ., 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.
I have and will maintain workers' compensation insurance, as required by
S: ion 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.
S'i ATE irOND 2219_9j C'N1T 0210110
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 'N'
) / 1 �� Applicant M 4
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 is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
nature (Owner/Agent) a •� �- Date
BUILDINGPERMIT PERMITCONTROLq
DATE VALUATION S 17.414 0,0t1 LOT TRACT 7362
362
-
JOB
ADDRESS !9'-931 IUf'.i,3 �1411CO
OWNER
CONTRACTOR / DESIGNER / ENGINEER
1;RUAM MCGUIRE
JEF ECTS
1855 E. DAY ISLAND BLVD.
73-960141014WAY I11, SUITF 5
TACOMA. WA 98,16i►
PALM I)ESERT CA 92260
(760).W-6726 011L4 5220
USE OF PERMIT
PCX)L ANL3 OR SPA
P00USPA, ALAlthi& flkabT!JZ8 SHALL Citi .1N kT PRF PLAPTP!
_P A I D
1.001. ANIXOR SPA 17,00,00 LS
AUG 12' 1998
%NiTi Y OF LA QLIIN
COST OP 4;.�`�iNS 17,0 00.440
�--V(..-r1o'N
P.IERNMITcull SijMiti ARV
PLAN CHF.Ci; FFJ 101 -OW -439-318 xi f'r (f0
rc'; tJ8TRT rr""t'I0N FIT 10 1 -000-4 t 9 -MO �1 RO,ZD(t
NU-01,04CAL 1,141—1"OVIL 101-000-121-000 �r^w; ijtl
iii•.E:t:;liiit'a�i,Fi:h--POOL 101.;0o0 -420 -CQ 515.i�J
11-t,t7NWIN0 F141, -- P001, 1014)0 -4.19 -OW S2719i
;�tt{I-'."AL CON fP-'Rl t("iiC3N AN 1) P1,AN CJ11,C9 �3r�z.(it3
LESS PRE -PAID FEES $0.00
1*0TAt, PERMIT FEWS 001", NOW S;9S.tit►
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
A.l t.
9
.i..4li\ ,f:
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
nniwall _ Int 1 nth
BLOCKWALL APPROVALS
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Fans & Controls
Condensate Lines
Final
POOLS - SPAS
Set Backs Electric Bond C_r��
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
_Underground Electric �� / /. `�"j Qj ,�4, 1'e"
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test _ l ZEE
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation �1 `G
Gas Piping
Gas Test
Final
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power