9905-139 (RPL).. _ wy., LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
f— Chapter 9 (commencing with Section 7000) of Division 3 of Pe°Business and
C4' W Professionals Code, and my License is in full force and a ea.
O: =)ih License # Lic. Class Exp. Date
d
LU,- C53 11130i n
I` I ipit MV
oZ Signature of Cont ctor
�p C) .�
J C) OWNER -BUILDER DECLAMATION
W WW I hereby affirm under penalty of perjury that I am a empt from the Contractor's
N License Law for the following reason:
Z ( ) 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).
C6 () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
O rn I "
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjbry 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.
(,171 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. MyS,workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
$TAIft,"FMI D 13a,1i1'"raR- it
(This section need not be completed if the permil adtion is for $100.00 or less).
() I certify that in the performance of thvwork for which this permit is issued,
I shall not employ any person in anymanner so as to become subject to the
workers' comp nsation laws of atiforn{a, and agree that if I should become
subject �th orkers' compen�tion Goyisions of Section 3700 of the Labor
Code, 's I o �i' rt con��wJth-thyfs fp signs.
Date: Applicant (.II j
Warning: Fail re to secure Workers' Cbmpensation coverage is unlawful and
shall subject an employer to criminal pe 1 alties 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.
j certify that I have read this applicatio nd state that the above information is
correct. I agree to comply with alleft, and State laws relating to the building
construction, and hereby aut}m Iz representatives of this City to entei upon
the above-mentioned proper v for Inspection purposes.
i
I/
gnature (Owner/Agent) Y� v Date
1
BUILDING PERMIT PERMIT#
9005-139
DATE 05107/1" VALUATION sj! IOwoo LOT TRACT
JOB SITE
APN
ADDRESS 79400 CLINDY COURT
- -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
NIR BIEKSv A
FAMILYI�..�iOLS �l.ON : i:0(.;,i11CIN
T9-100 CINDY COURT
53300 AVENIDA IiAMIRIZ
LAQUINiA C..A 94253
LAQUINTA CA M53
(760)564-3655 CIBIX 2893
USE OF PERMIT
A(aOL SPAt 9LY - ALAIM&i3f>,RRJERS MUST KIN PLACE AT
i?1tt:-#%1.14�'1'i:k tNSi'Et, Tt��1.
POOL AIA)IOR SPA 15,(0100 LS
PERMIT FEE SUMMARY
PLAN CRE K.Hh IU1-UQU-439-31it S105,30
C,0 W.TrRVJ(,'rV0tq FSS? W2.00
tats, ITAINICAL I i s •-1'£'a, 101-000-421-000 3101M
L'LI3C'AZIC;AL VEL --POOL 101-000-420-000 S4A.CA)
k1.1JNlBING FIX -•- I'()0L 101-0ff(i-419-000 sb.w
SURM:11I AI, C't.1�MWR:I[JCTION :'l:N0114,1N CF (P(: X �
'$246.t Y)
LESS PRE -PAID FEES
$U.00
TMAY, PERMIT 3+' E'S DUE NOW
$ 363.311
!t�
RECEIPT
DATE
BY ll
��h
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
ReturnAir
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 Pibg. 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
OX 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 Voftage Wiring
Fixtures
Main Service
Suti'Paneis ':.
Exterior Receptacles
GYJ:
Smoke Detectors
Temp. Use of Power
Finale .
Utility Notice.(Perm)'
COMMENTS:
9
a
00
0
20'
i
12' !
BiEKSHA HOME
79-100 Cindy Court
MARABELLA PROJECT
7�
F, ,.:.
BUILDING & SAFETY DEP,�yR
CONDITIONALLY
T�i��T
ACCEPTS® FOR
CONSTRUCTION
ECT TO INSTALLATION AS PER
0
APPLICABLE CODES
�C�i�'Y000Ly ��
v
Construction
Pools Spas Fountains
(760)564-3655
Lic. #658996