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o Z r Date //;;5/Ulo Signature of Contractor
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U OWNER-BUILDEREDC RAL ATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) 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 (See. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
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`(-) Imam exempt under Section B&P.C. for this reason
7a a 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' compensation insurance carrier & policy no. are:
Carrier STATE FUND Policy No. 10614"-00
(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 I should become
subject to the workers' compensation ---. visions of Section of the Labor
Code, I shall`forthwith comply withihose provisions.
pate: Applicants i
Warning: Failure to secure Workers' Compensation`coverage•is_ aawful'an'd
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages a�rovided 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. j* J
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
th/ebove-mentioned property for inspection purposes. //
Ignature (Owner/Agent'��- tey- 1
BUILDING PERMIT PERMIT#
DATE VALUATION LOT' (K)04-" TRACT
$1,000.00
JOB SITE
APN
ADDRESS 79-100 CIT.f.us
OWNER
CONTRACTOR/DESIGNER/ENGINEER
SCTR'AD /
DATE PALM MTRPRISP'S
79.100 CITRUS I
81-965 M -01-W" VIEW 1,.AW1
LAQi.FINTA CA 92253
LAQTMSI A CA 92253
(760)398-1766 CB14 1888
1
USE OF PERMIT
POOL AND/O:R SPA
POOL & SPA ON1,Y - ALARMSMARR1ERS SHALL HE IN PLACE AT
PEE -PLASTER INSPECTION
VALUATION 15,000.00 LS
RSIR"aIND COST UP CONSTTRUC ICON
1510W.00
PST M SSCi NtA:>x Y
PIAN CHECK FEE 101.000.439.318 $105,30
CONSTRUCTION FEE 101-000-418-000 $162.00
MECHMICAL FEE -• POOL 101.000.421.000 - S24,00
EIZCTR.ICAL FE.P -• POOL 101-000. 120-000 $45.00
PLUMBING FINE -- .POOL 101-000-419.000 $27.00
fi
SM-TOTAI. CONMRUCTIOM AND PI..le1~I' CT•1 ICK
$363.30
LESS PRF;' -PAID PF.M
$0.00
TOTAI 1'xIT MY DDE NOW
MAX)
RECEIPT
DATE
Y!
DATE FINALED
INSPECTOR
01
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I
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
Insulation
Compressor
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
— w
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 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:
03/31/2000 16:12 7603988935
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