9912-053 (RPL){; LICENSED CONTRACTOR DECLARATION
I hereby affirm under, penalty of perjury that I am licensed under provisions of
Chapter,9,kr.Oin6iencing with Section 7000)*of Division 3 of the Business and
•P�y� Sionals Code, and my License is in'tull force and effect.
�."License# Licriflass Exp. Date
t ., r . 7
Date Ih A 'Signature of.Contractor \ ✓�+, •^,Z +�
r. 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 '6f the'property, aexclusively contracting with licensed
contractors to construct the project'( . Sec. 7044, Business & Professionals
Code). f'
( ) 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 hof 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 w Policy No. ,
..1e f�J.:�!• _+1`a��- !hfV•.r✓ .R+t•t).14i!•••/
(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,l should become
subject to the workers' compensation provisions of Section 3700 of the Labor
-Code, l shall forthwith'comply witht ose provisions
Date: /�%.�` AX7 Applicant " /• C'^"ob
Warning: Failure to secure Workers'-CompensationacoveFage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. ,
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for,whose benefit work is performed under or pursuant to
any permit issued as a result'of this applicaton agrees to, & shall; indemnify
& hold harmless the'City of La Quinta, its officers, agents -and employees.
-2. Any permit issued as a result of this application. becomes null and void if
work is not commenced within 180'days from date of issuance of such
'.permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.146
J
'Signature (Owne'r/Agent) �• Date j
'• + PERMIT# •• t' �
BUILDING PERMIT
DATEi VALUATION r� j� ��f LOT TRACT
I C
JOB SITE ( ' •-•' ' •e+ .ra ,•
APN
j 2 DRESS
.OWNER,..
CONTRACTOR / DESIGNER / ENGINEER
'r'.a A61'� 1 �j rd i JY •:L'7l1i1� fr, F�"
F L. .'4i•"11 it, a. 1y1, 'i a;.I.NJ" tS �.,
f j ,�!'1'I 1Af1n t1/ YiL S f4 K 1)ht;
ri,.•/d eJ r. J'ia4
•..,RRf \ar .... •q,• .7.. tl..ft�
I .�%�.,. /
ti.�f7. (.:,4
/4l-/1 S J��N11 ON'l V E, M
i,.1� Q: Ui;1`rly C.A. 92251
}'ALM Cay 92.7,60
USE OF PERMIT
P00-1—ANNOR R SPA
Tit,rtPi,h:;P ij_34Q(ANP,j i;:, t • � y-, �:P:) til{:.[��C11 r>tY .t�dCi liE4:i ).1iP�2 f, t +G k;V
+00,11, ,t1 Vi01Z SVA i,3V-0 G SJ
O�C'Y''$R'i �•s 'P,`il ,Y°j.Pt6: •f i'iT':'f'�X,i4t'>:'i:7raif-•'7f'"i J'`\Ai
l'w, !. Di.tl o. i'+LY 0.K,J1d J'. 3 X' s—R 14.r .i ),�.!!'l.1 Yl,•rit
rry1/1J1 111i
r-�.C�+il:tBB49
:'FRAM cam' 1,TZ %U&ft L,_%Rx
PLAN CJbW" K t FEE
t7)M -rPU'f;'1-10tJ V_,FF if3f.f?i1{?-.iffd-i?tsfl <?R<+11r
FIVE ,••./. 0,1. 4•-00.421•01:0
t.t is--�h:P;✓I, Iv(``i•-i��)) �i�:�-ui'�Cii+�ppiS.�.h�
• •
TT.�',,a
taILUA41iI Q i1ti{{L ^ POOL
L 1t.1l.•"t�t�(1 l:��'�.t,JtaYy d�'.IJU
/ fii,fFi-'��f,At,r't-)!v`,'�i'i~i'r'°'i"i,i1'Z /t�Jt) r'8,'i�� C ibt•.i;l>
.. .. -
a ,�j�!(}7,hz
- C •QC• ti•il r1 A 1•Y }}
SJ.I.r-+.." e.ir•t. f ID A•�.
- •'�'t.,a' +P#li f�+J��li't.{' $•TJS�N.P 3/��% I��X�'Y
t - ' .^+R��J.1'bi 1
^•-�
RECEIPT i
DATE
BY, r
DATE FINALED
INSPECTOR F '
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
�"et Backs
Forms & Footings
Slab Grade
Steel
!Roof Deck
0.K to Wrao
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Parti Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
Final
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
Final
POOLS - SPAS
Steel
Electric Bond of
Main Drain
Approval to Cover
Equipment Location ,%
Underground Electric /
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 Pinish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underqround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power