9906-169 (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
r:�ofessionals Code, and my License is in full force and effect.
License # Lic. Class p. Date
Z
2 947 C -S3 f,4k
U . 5ttAx
,
A ��!� '1 Signature of Contractor
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 Sionature 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.
(Q 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:
Carver Policy No. NOWC-338 J S6 103
(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 s to become subject to the
worker5,00mpensation laws of California, and agree that if I should become
subject to the workers' compensation' rovisi sof S ,tion 37 0 1 f the Labor
e.
Code, I s all fo hw h comply with < bs p ov ions.
Date:P ?c Applicant _.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his.4
application. r
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to r
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void `if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180.days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City d State laws relating to the building
construction, and hereby authorize r pre. entatives of this City to enter•,upo I I
the bove-mentioned property or in ectio purpose .
J7q4fSignature (Owner ent) ate
BUILDING PERMIT PERMIT
t'��
DATE
f j� VALUATION S16,9✓ .Qf) LOT TRACT
/
ADDRESS 4$-955 AYGN.i3A.L NI!))
APN 63:x -3111-01):i
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.:ICH.A..11U) & MkPWN GINTIN
N1,AS T ER. F(YOLS
48955 AVEN DA EL MDO
73-555 HIGHWAY 1.i 1.
t A QUINTA CA. 92253
PALM 'DESERT CA 9220
CRL# 16
USE OF PERMIT
P+Jt3L r.1NDADIR SRA
FOOL Jk V N0NL - ALAtdt LS03ARI- iT"Si`b LL BE 1N.P11.ACE AT
PR %- %A:,T l R IN:aC'.?s i'dt7K
16.94WOO L3
1���YS:t.A.1 - t, t,,, A1. O C'6df'Y ��U1.1.�.0 .�!\JL Yr
Y.41�'W�.'UU
PEIkWf FE 54JARN
i?.LAJN CHECK YU' $1.17.00
CCfNMIRI!CT101NFIT . i0!-(111"1 19-4x'st$180.00
in 1t -Sr -? -000-421-0)tvi ���a�zf.ot,
El,EC.XRtCAf.1T,8 -- POOL 101.OW-4210-000 $45,00
PLU4fBINI G FIX -- ['+QQ;L, 1f)t-OCff?-�t.4,S'wtll}U bz`P.(1i
R�
•
$393.00
LESS Ras-I'A.ID FEES
$0.00
T(YfA1i. VE.mtM:fT €t'ECS 1)iJ11'NIONV
S393,00
JUN 2 91999
tl�E �+-
y
DATI�jfil 1A
BY/ -,�
�
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
OX 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
steel
POOLS - SPAS
Set Backs
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 Fina!
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
e
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
il
F. -PAR -a. BIT
0RVON A
C�P'A,,!l ALLL
G01 � TRUCTION
SUBJECT TO INSTALLAT80N AS PER
AN ALL APPLICABLE
DATE BY
71
31
POOL AREA TO BE ENCLOSED BY
MINIMUM 5 FT. HIGH FENCE.
ALL GATES TO BE SELF-CLOSING
AND SELF -LATCHING.