0008-159 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm undeee natty of perjury that I am licensed under provisions'of
Chapter 9 (commencing with Section 7000) of Division 3 of the Busi en ss and
Professionals Code, and my License is in full force vd^effect. 1
License # Lic. Class `��= ate
Signature of Contracfbop�
J"
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,exelytpt,44 Section , B&P.C. for this reason
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' compensationJr-isurance carrier & policy no. are:
CarrierE?GIMP,1 �. Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the workxfor 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' compensationprovisions ofSecti n 3700 of the Labor
Ae, I,sh—dill-�ytfiwith comply with/thoseI� ions. 1�,' �.
Warning: Failure to secure Wo.ke"rs' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on'.: his
application.
1. Each person upon whose behalf this application is made & each person atv
whose request and for.�whose benefit work is performed under or pursuant to:.
any permit issued, as a result of this applicaton agrees to, & shall, indemnify'
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from,date of issuance of such
permit, or cessation of work for 180 days will) subject permit to cancellation. .
I certify that I have read this app
correct. I agree to comply with <
construction, and hereby authoi
re
state that the above information is "I
State laws relating to the building,,,♦
Atives of this City to enter upon
purpose
— Date
BUILDING
PERMIT PERMIT#
DA VALUATION
LOT ^ TRACT
JOB SITE
ADDRESS
7°`815 NAMIA
APN
_ 4
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CYA:i �1T
'tiAi TYY P60L. & SPA
79.815 SANDIA
4743 CR PALM (`.IMONDR, #116
LA C -MrfA
CA 92233
PAUA SP1wCs
CA 92764
(76d)?78-39:39MIN
2565
USE OF PERMIT '
(POOL A1,M/OR 8PA
SPA 074LYALARMSMARIEiS SHALL BE TdPLACE ATPPa PLASTER
I pPECTION,30' 1000. JARJMWaLL-VJqySTJVDARD�
POOL ANDIOR, SPA.
11,000,00 L9
ST1AM
fLP] D C01r ' OF CANS` RATC f.TOX
15.000.00
��$yra�+ "yf,; y �V{wyu�r� /�' �� 'Qi
PERM
.K�.L:..I��C If FFX IYUhFilY3.SI4.Li,.
PLAN CF1W-1C FEE
101-000.439.518 $105 30
COAiSY'RUCTION FU
101-000--418-000 $162.00
MECHANICAL FEE -- POOL
101-000-421-000 $24.00
KLEi`TIRICAL, I7EE -- POOL
10'1-0100-420-000 $45M
Pi.UMBINO FEE .: POOL
101.000.419.000 $27.00
,4
SUB- 110!f M, CORVIRIUMONT AND YLkli CBh-CX
1;.23 PRE -PAM mwi
$0.00
r
PAID... .Ce/MIL, FERA-'.l.bdyd r .'.T.3 DAV_ .!!O7Y
+
AUG 0 9 2000
OF LA QUINT
J
RECEIPT
DATE
Br1 }F)jj,}//�
DATE FINALED
INSPECTOR
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
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
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:
C(�
V