9709-026 (RPL)LICENSED CONTRACTOR DECLARATION
?��by 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. Cla / Exp. Date
7T r25,2 C_ 1 Zit1l9S
Date Intl7'Signature of Con, Y lAw-, _,
OWNER -BUILDER- DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: 11
(• ) I, as owner of the property, or my employees with wages as thein 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 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 Policy No.
SA,A,Ay iJ �1 f,! tl h+`t 'r!^9t
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) J certify that in the performance of the work for which this permit is issued,
I shall not employ any person in agrmi anner so as to become subject to the
workers' compensation laws of Califolnia, acid agffge �h'at if I should become
subject to the workers' compensatio Apr�sisions df Se ion 3700 of the Labor
Code, shall forthwith comply with ose prove '(o s.
Date: -�� "G Applic,rants 4
Warning: Failure to secge�Workers' Compensation over ge ' 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 aft
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 repre ntatives of this City to enter upon
the above-mentioned property foins' ction.°u�rposes. Y
!e !l% �., y e ~ 7
ignature (Owner//Agenjt� Dat
PERMIT # CONTROL#
BUILDING PERMIT���>s-fib
:. 4
DATE
VALUATION,•,�i LOT TRACTJOB
c
SIT—1
ADDRESS FJv1•�.i
APN �r
. OWNER
CONTRACTOR / DESIGNER / ENGINEER
VIA1'�0 t NTSCA4e
fif.tNMR K,101.5
11.83 S Ai'FNI'DA WAR U,
GA.tZ113WA Cc! !:212 3
PftiW DESERT (;A, 261
€his.0 5
USE OF PERMIT
11001. ON -L. L A-- 5.0t 0 i/LOCK WALL
X13' •i`. �af4'1i,i, �'r.r,#t) L'c"
a s xsn� a tro {�C a> irea r'1/y]�s �r ►i M��y+��
i1;d1 A-Ei�-iJm.� 5',etJ f4�'�1Ap .tl 'V lV t�9•11�b ����'Er.i.:i:+i,b.i♦
0 . 40 aia
- .�i1;✓l�,�r�
PERMIT VET, NUMM"N'
PLAN CW,4C7K FT:6 -4,19-318
A4,K-4 AI ffl. FTE-- PCX-it, #t91 -f01-17 4X10 5V fri
3�3.l A f31J�tt FE. kC.X3,L 1p1.G lu ��.15� ilii Z7.ii►)
IC.f°tftit�iFEE to.1-000-4180JO �t'�d5.f.s�►
PAID
SEP^ 0 8 1997..,Na';���`�'tt�,
CITY ®F LA QUIIVT�
A
RECEIPT
DATE
ByDATE
a,
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
OPERATION DATE INSPECTOR
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
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 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 Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS'
'�
�j
/'
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
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AND ALL APPLICABLE CODES
BY
PLOT PLAN
GENERAL SPECIFICATIONS
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PLOT PLAN
GENERAL SPECIFICATIONS
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Name )n Azuo y e- s
m*m'5-3-93s- Ave-
sty Lw Q U 'nil -r4 l X09
Crom Strom rz o 6 o
Phone
omwo*-2 6-1/Drwnby: 4,44 L,>,�° z
SUNAIR
POOLS
SINCE 1974
FO BOX SM
PAW DESEIR CA
PHONE " WS4014
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