9911-017 (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
r 4K3498 B CM 1213.1119°
-YDate /fA�/`� � Signature of Contractor / +� ' f L�"l'+� �
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 Policy No.
1.i:GlOIN INSUMICE i a iia
(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 hall forthwith comply with,those provisions. .
r
'Datei.,� y y Applicant / 'e^ Urtzx. (-I. 60,x.Z e.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions .set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
./Signature (Owner/Agent)( .�' -�'� f� �' Date
BUILDING PERMIT PERMIT
DATE t , VALUATION ( LOT TRACT
JOB ADDRESS 7g-574:SiAuN hI.2? MANO'ji'�URT APN r
OWNER t y� y y?( t �y {�� r {y t / CONTRyA�C�(TyO{R / D�+ESSIG[N}ESR //{ ENGINEER
.� C,(�y � � (/ •v�+(/y
I'1i.)t�M?-IJii6:l�ii%�i(:�liRIGIER it 111.Sselc i-l.J l�a {1FFC. Y' P �J1. L"S IkM.i 4� N!*, IT, C ON
7841:5 NAPLES h DRIVE P.£:3. %3OX 1524
LAQIJ11V'3A CA 42253 PAfA DES}:'WC CA 92261
('thf};.'+£ifI-4EKs3
01L0 M
USE OF PERMIT
k''lXX A D aR SPA
POOI: A1u7) NIA ILIIVLY - A.4iMS nidi utiRRii;KS SHAL . Lsi; 114 .4 LACE &T
11KH ill. A:3'i' R f;2+3111 t`1710N.
000L r1Xvi?lOR SPA
1I,41t10,90 I'S
RMii FEE fit. �?,.�'�°�:�'1.�'�'.i'Ft.'#3 i"t}.�`�' �`��� f:t�4Y:►'X.I'$�ATI"7('�:4)�1
UMNURY
NiUCIIIANk£.'Ai. FUE—.P601, 1011-M-421-000
EL r'MU'At. PRE --'rbc,), 101.010-4V40
£°i.UMBING 111M -• POOL 11111 -0W -40 -OW S'a7,f�U
PLAN CIXCKF0,. t4i-0<Dii ✓139-3 g $87.75
C()NSTRVV110N FEE 1W -W0-418-000 S05AXII
SUR -1 YE L, t'O S"' V i(71TIN AND PLAN t';t•+1WK
LESS L aI.L,4121JI) I110E11%
MIA), PERMIT FEKS DUE N0W
".1
,L— ,Xt
RECEIPT I DATE I BY I DATE FINALED
INSPECTOR
$11 fi 71
$000
S318.1"1
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 Firewal
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Set Backs
Footings
steel
Electric Bond
Main Drain
POOLS - SPAS
/—
Bond Beam
Approval to Cover
Equipment Location
Final
Underground Electric
Underground Plbg. Test
Gas Piping
G�
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
L —
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
17E P
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:
3
O
0
32
14. 92' PAD 1 1 2.9
F. F. 1 1 3.40
PLAN 4A
UFFY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
OR CONSTRUCTION.
DAT BY
80.00
A RE -INSPECTION FEE OF n 0
HILL lit UmtknuLu 11 1- " nM
PLANS AND JUb LfHnu "" 1111 v.. -
THE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
L-
O
0
0
0
Fl
'0 J
7'o-,5-74 SCALE 1/1e" -,'-o"
&ASSOCIATES BELLA VISTA PHASE 6
Prof -i -d rte„ for C-0- NKts Ia t— PR► c—c—
'
ti
7'o-,5-74 SCALE 1/1e" -,'-o"
&ASSOCIATES BELLA VISTA PHASE 6
Prof -i -d rte„ for C-0- NKts Ia t— PR► c—c—
'