9911-142 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions c
,Chapter 9 (commencing with Section 7000) of Division,3 of the Business an
Professionals Code, and my License is in full force and effect.
License• Lic. Class Exp. Dat51013,
Date Ignature of.Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor'.
License Law for the following reason:
( ) .1, as owner of the property, or my employees. with wages as t•heir'sol
compensation, will do the.work, and the structure is not intended or offered fc
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with license
contractors to construct the project (Sec. 7044, Business & Professional
Code).
;O I am exempt under Section B&P.C. for this reason
3Date Signature of Owner
WORKER'S COMPENSATION DECLARATION'
I hereby affirm under penalty of perjury one of the. following declaration's
() I have and will maintain a certificate of consent to self-insure•for worker;
compensation, as provided for by Section 3700 of=the Labor Code, for th
pgrformance of the work for which this permit is issued.
(Y-'Thave and will maintain workers' compensation insurance, as required b
Section 3700 of the Labor Code, for the performance of the work for which thi
permit is issued. My workers' compensation insurance carrier & policy no. are
CarrierPolicy No.
ST fA-E�E.ItD �f3 ?9�fF4L�Vt�ty2
(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 issuec
I shall not employ any person in any manner so as to become subject to th,
workers' compensation laws of California, and agree th t if I should becom,
subject to the workers' compensation provision Se i 3700 of the Labc
Code, I sh II w,i r compI with thosd`"rovl I s.
Dat /�' jAPPl,cant
Warning: Failure to secure Workers' Compensation coverage is unlawful an,
shall subject an employer to criminal penalties and civil fines up to $100,000, ii
addition to the cost of compensation, damages as provided for in Section 370
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made. to the Director of Building and 'Safet
for a permit subject to -the, conditions and restrictions set forth on hi
application.
1. Each person.upon whose behalf this application is made & each person a
whose.request and for whose benefit work is performed under or pursuant t,
any permit issued as a result of this,applicaton agrees to, & shall,.indemnif
& 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
work is not commenced within 180 days from date of issuance of sucl
permit, or cessation of work for 180,days will subject permit to cancellatior
I certify that I have read this application and state that the above information i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize repres ntati esof this City to enter upo
the above-mentioned propertyif r ins fph pu o es.
c
J Signature(Owner/Agent) ► Date
I
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BUILDING PERMIT PERMITN
� j� B•;:C�b
J
DATE I) ,1"VALUATION 51!'.g00041 LOT 1.8 TRACT
9
JOB SITE 'rig 9$15AN MARINO C;015M
APN-014W38
ADDRESS
OWNER
CONTRACTOR /DESIGNER /ENGINEER.
•
ROMER' SNELiEppBEyyRlLR &.ASSOC.
etMCYN) POOLS'
791615 NAP.L.ES DRI k .
2 `. �tAI.i�SvrJi4 .iL ri�i3
LAQU:fNTA. CA, 9221.9
LUC:E E V.e�,:LoLIE t'A,
92'-1..50
C911# 43335
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USE OF PERMIT
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1700L r1iNl:Jtt;,)R SAW,
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VLAN C.W. " X 1 -'EF, 101-000-439-.318
121'r„''*`IQN!ME _103.-000-43.8.0100 '$16100
MM-3i':rIN CAL Y'!T:"s — P00L 101-000-42141000 V114.001
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ELEC"i'IZJCA:(: f"03P00i, 101-000424-000 �45.Qu
i%LUTA,fit.1.>':O FEE = V100 1, Sf}u-f3r�!•4;.9�t� S27,010
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RECEIPT
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DATE FINALED
INSPECTOR
I
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
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Hacks
Electric Bond
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
COMMENTS:
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)