0203-193 (RPL)LICENSED CONTRACTOR DECLARATION
I hareby 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
Date 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).
( ) 1, 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 �z
Date .1r i, r 1 I Signature of Owner 1
WORKER'S COMPENSATION DECLARATION" WJ��
I hereby affirm under penalty of perjury one .of-'tfie 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):
,%O 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, A
Date: / Applicant ` +
t{',2,'?/'
Warning: Failure to secure Workers' Compensation coverage-is'4unlawful 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..inspectio' purposes. f .
Signature (Owner/Agent) " �y-� 1 - �x� Date
^' PERMIT#
BUILDING PERMITv
DATE J VALUATION LOT 0203-193 TRACT
krest r..lub
JOB SITE
APN #
ADDRESS
1,94545 SAF- V,taR'ti:YSRI` E
OWNER
CONTRACTOR / DESIGNER / EN (NEER i
i�ir%i LN,d
1YON'.t RT) LAM
1 i��yy!Ln1•£+.�L((;}�'��Ejjrf�
+�Ar`,,.�.;iry.,j��F:�t'�_�����.�;':i..�;
// AA ��'p!�fyy d/��
X'J' U Af�7.KP L CA 7,G26RI
y13nn;''t p 91y(/•�
CALM �L.li,h�J.::t).57. CA. q- 2260
USE OF PERMIT
POOL. AMEW R ITPA
POOL AND SPA ONLY. A341M MISMARRI'W SH,kLL BE IN PI -ACE 1'PtliOR.
TO 1"UPLAS T 1'A I130PRiMOK P1001, EQUIPMENT PiJOLOSUFYE:NOT
INCLUDED IN PZRMIT.
POOL til' DIOlt, SPA 4008,00 u
E:4'I` MA27M C`+DEr (:tidy 0.01* •W1;r'1TUIiE0H
PL#s:'HTSi:KftE MM
9
COIMISMUC'I',ION PEE 101.000-411.000 mco
DARCHANICAL FFE --''POOL 101-000.421.000 SX(
n
ELW,TIZIUAL FEE — POOL 101-000-420-000 WAD
P1.LtMii11 O ITZG - POOL 101-000-'419-0W 29.t8
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114
W Atli) PLA01 CITE 0-K.
. �_. LESS PRE -PAM) M. h
4
BOW
APR 04 2
RECEIPT.
DATE !
BY
DATE FINALED
NSPEC
nVX
It
t1lN�IIU7 wit 9
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 gyp/
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 XA
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation — 7—
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
F•nal
Utility Notice (Perm)
COMMENTS:
))o /VbT ISS V- u%17 -(C, ),o✓S;C-
Bfn #
City of La Quinta
Building at Safety Division
P.O. Box 1504; 78-495 0110 Tampico
La QuInta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
/Q3
Projcct Address:-)(- 78-5145 Sa#uaro-D---
Ownar's Name: —)�- Leowta.rd. Laaw
A. P. NMber•. 6,46-313-0014-
Address; -je 111 Cheasea.CCYCLe1
Legal Description: Lot 104, 17e�evtClulrMa�wrTractno 1
Contractor: LeoYLa -d/La m (o"One-')
Address: K111 Chehea.CCrcipi
City, ST, Zip: -)k— Palv;v )ebevt, CA 92260
Tele hbne:
Project Description: -
City, ST, Zip: *Pa +mDebeXi;, Cil 92260
S wimming pool
Telephone. 340-9882
State Lica# : 78002 City Lic. #:
Arch., Engr., Designer.
Address:
City, ST, 7.ip:
Telephone:
State Lie. #
;
>s;
Construction Ction T e: Occupancy:
YP P Y:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person: Leov►.a dl Lam
Sq. FL: —# Stories:, 7# Units:
Telephone # of Contact Person: x'340 -9882
Estimated Value of Prgiect: -)(' 5,000
APPLICANT: 00 NOT WRTE BELOW THIS LINE
#
Submittal
Rc 'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Caics.
Called Contact Person
Plan Check Balance
Title 24 Coles.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
Zed Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up .
S.M.I.
H.O.A. Approval
Pians resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Coutact Person
Pub, Wks. Appr
Date of permltissne
School Fees
Total Permit Fees
Proposed pool
i
Plan for:
i
78545
Saguaro Dr.
La Quinta•
I X
TY OF LA OUINTA
APN :
BOLDING &•.SAFETY DEPT.
a
646-313-004
i
OAPPROVE
I
s � OR CO STRUCTION . .
�
Owner builder:
.
.
Y OZ s
Leonard Lam
I
DATE BY
Tel: 340-9882
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32 inches retaining wall' and 6 feet/'bloc.k w 11
on top
CITY OF LA QUINTA SUB-CONTRAC-I UK 1-1151
JOB ADDRESS PERMIT NUMBER OWNER 41!— BUILDER
This form shall be posted on the iob with the Building Inspection Card at all times in a conspicuous plpce. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to,this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of buildino permit_ Fnr Parh annlirahlp trariP all infnrmnrinr. , —+-A i i ... _ L_
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Company Name
Classification
License Number
Exp. Date
:'-irrier Name
Policy Number
Exp. Date
License Number
Exp. Date
(e.g. A, B, C-8)
(xxxxxx)
(icxlxxlxx)
(e.g. State Fund, CalComp)
(Format Varies)
(xx/xxlxx)
(xxxx)
(xx/xx/xx)
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CONCRETE G-81 fi;
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Ortega and Son's Roof
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762849
3-31/03
State
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State Funds
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3085
12/31/
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