9804-108 (RPL)LICENSED ,
WTAACTOR DECLARATION
I hereby affirm,under penalty of. pe r jury that I am licensed under provisions of
Chapter 9 (commencing with S6dtio"n 7000) of Division 3 of the Business an d
Professionals Code, and my License is in full force an&effect.
License # Lic. Class Exp. Date
C-53 CA M
,oate Signature of Contractor,
TIO
I hereby affirm under penalty of perjury that I am exempto-from the Contractor's
License Law for the following reason:
( ) - 1, as owner of the property, or my employees with wages as their sole
compensation,'will do the work, and the structure is riot intended or offered for
sale (Sec. 7044, Business & Professionals Code).
1, as owner of the property, am exclusiveleyeontracting with, licensed
contractors to construct the project (Sec. 7044, BU ness 9 Professionais
I am exempt under Section .10, 11 B&P.C. &rthis reason
WORKER'S COMP.EVSATION PECLARATION
l*hereby affirm under penalty of perjury onp�lo_f the following declarations:
( .) I have and will maintain a certificate of 60sent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
Perfo�mance of the work for which this permit is issued.
kels6' mpensation insurance, as required by
,,,,4hav6'and will maintain wor 'co,
S'0ion' 3700 of the Labor Code, forlttfe,, performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
044-97-0020325
(This section need not be completed'Irthe permit valuation*is for $100.00 or lbss).,
I certify that in the performance 6f the work for which this permit is issued,
I shall not employ any person in an7
,ganner 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: — Applicant
W�rning:Failure msecure Workers' Compensation coverage is unlawful and
sh6ll subject omemployer mcriminal penalties and civil fines upm$1m\000.m
addition mthe cost cfcompensation, damages euprovided for inSection 3708
ogueLabor Code, interest and attorney's fees.
'^IMPORTANT Application iohereby made mthe Director mBuilding and Safety
for a permit subject to the conditions and mmxmiono set forth on mo
application.
1. Each person upon whose behalf this application iumade & each person a,
whose request and for whose benefit work ioperformed under o,pursuant m
any permit issued ooa result ofthis app|icamn agrees to, 8xhan`indomni
& hold harmless the City ov LaOuima. its officom, agents and employees
u. Any permit issued as result ofthis application uonomoa null and void if
work is not commenced *umn 180 days from uoto of issuance of such'�
permit, or cessation of work for 180 days will subject permit to cancellation.
| certify that | have read this application and state that the above information is
correct. | agree to City, and.State laws relating !othe building
construction,and hereby �mx n tati of this City to enter
.a T9ses.
Signature (Owner/Agent) ate 4/0, 11
BUILDING PERMIT
DATE. VALUATION LOT .9804-108 "'TRACT:1
7076
JOB SITE
APN
ADDRESS 43-652 PALERN1.0 COURT
.dWNER
CONTRACTOR DESIGNER ENGINEER
-7861.5 NAPLES DRIVE
68-465 PEREZ RD.
LAQUINTA CA 92253
CATHEDRAL CfrY CA 91-234
W)3128-2681 CBLft 69
USE OF PERMIT
P60L ANID/OR-SPA -14,$00.00 LS
ESTINIATCD C0371701? CONSTRUCTION.
PERMIT FEE SUMMARY
PuILN CHECK FES 101-000'439-318
CONXI'RUMON FU 101,000-41&000
NIF-CHANICAL FEE :—POOL .101-000-421-000'
E-LECTfUCAL FRE —'PO01. 101-000-420-000 $45.06
PLUMIMNOVET —POCL 101,000-419-M $27-00
540TAL CONSTRUMONAND PLAN' CHECK
Or
RECEIPT
DATE
BY
DATE FINALED.
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
T
MECHANICAL APPROVALS
Set Bareks
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 8 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 i
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric zf
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
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
t
mail
0014 Notice (Perm)
COMMENTS:
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CITY OF LA QUINTA�
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRNJOTION
SUBJECT TO INSTALLATION AS PErq
AND ALL APPLICABLE CODES