0402-032 (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 Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
6146131 %C153 3/31/99
Date/111c f./ Signature of Contractor
o
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
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 CIhA1( ENDOW NATIO' Policy No. 01KR0001440
(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:2 &VA Applicant G
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) '�: -f� = Date Ji ?h
BUILD1'NG PERMIT PERMIT#
DATE VALUATION - LOT 0402-M2 TRACT
JOB SITE
APN
ADDRESS 7S - 7 7.5 SAf"3'1'r'B'Z`2.UNH AVL.rfM'
OWNER
CONTRACTOR / DESIGNER / EN (NEER
I1C>IG .14:A7`I: e?P LS
MClNTYRE POC L,8 & SPAS
74-923 131CIRWAY I I I S'I?? Al 14
P.O. BOX 1791
Xt4T)U % VIlE'F.:L$ CIS 92210
LA, Qi W17A CA 92253
k°760)342-3612 CMA 1945
USE OF PERMIT
POz;3LAND/CYR SPA
PCtC21 AWA— ALeAk2A,4Siti.A '' ' ERS SMALL BF, IN Pl. kCL AT 4Ptt&Pi,FL,�STF.R
rNSPE.ts' ION. EQUIPMENT ENCLOSURENOT INCL1.ii7W
")L AND/OR SPA ,x,000.00 is
1+:5i.1x1�iAIND COST O1iis' CO1V'S'RUC"11I0H
151M.00
P' c.M OYS Te1X
PLAN €'11FM FRE 141.000-439.318 V0111315
CONYrk.UC:TI014 FM 1107-000-418-000 $162.00
MECHANICAL £4:.I? -- FOOL 101-000-421-000 S24,00
ELECTRICAL FEF — POOL 101.00"20-000 $45.00
PLUMBY00 FFY,, -- POOL 101-000-419-000 $27.00
D Q �
FEB 19 2
04
CITY OF LA QUI
TA
FINANCE DEPT.
`:3 YB-TC)TAL, CONI TRUCi:lc: N AND PIAN CTiFr X
$363.30
T OS TIRE -PAM FM
$0.00
Tonvi. rurnwr ms mm- now
-V
RECEIPT
DATE
,
BY- '
FINAL D
f� —
INSPECTOR
i
j
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 Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
a— _
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
Willy 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:
M342-;-3612
CITY OF LA QQINTA
BUILDING & SAFETY„DEPT.
APPROVE®
FOR CONSTRUCTION
DATE 2 13
l
3�
4i
Fb Pebble Finish
0�
Ea u i gment- Specifications
Pool
1.5 .H.P.
Filter
CCP 320
Heater
250,000 btu
Light
Spa 100 watt
Light
Pool 400 watt
Home control CCP 100