0110-020 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class
�f Exp. Date'
5330 y C- '3144TC f B{aidN1l7{, .
)Date ��, �.P 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 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.
(Mr) 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 2VNI'!`H Policy No.099M501.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: iZ7 hp b Applicant
Warning: Failure to secure Workers$ bompensation'ooG&age is u`rllawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. f
1. Each person upon .whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&'F old harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for•inspeciion purposes.
Signature (Owner/Agent)��'-- - Date -/Z")
BUILDING PERMIT PERMIT #+/1 �.
d
,
DATE t?i`.> VALUATION �*"� LOT TRACTJOB
SITE
ADDRESS 5;4-313 AVEMMA NAVARR wO
OWNER
CONTRACTOR/DESIGNER/ENGINEER
�(i 1`C(T�etNIV R
.
018Bj1U "Y�£Y��CkY�G.�9 )l�j,]b
�3R9
11
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53-X313'A�.N'.t.'.8�.".:dA.C`ti��b-� V.0
(�At�i7R�,;CdCom.
68"$,0 / BIJaN-1J,A �:S.bi�,�'�n .
L,f+;. QtY..W A CA 92253
%'1I T RAL +C=`TIT CA 92234
1
1;160)323.4510 MEN
USE OF PERMIT /
P 001, AMNOR SPA
REM 0DL?L'0%P-POO1,RVA„ .It LA_R.W st3E AR&t1 TLS WiALL. 89 M PLACZ .AT
PR2-Pte,"'a`,�T R INST�s:�."`xION. I4zaOLXQUIPMc:Ai`;i' -'. C..WSURKNOT
'f'�'t-d1..i30Yf•O
PLAN MECK M- 101-000-439.318 S1117100
CCkNSTR€irCTk4,tM K&E, 101-000-419-000 $19010
3
US0.11ANIC,taLM --Pool, 101-4100!421-M $24,00
u1. 233Ca,+4i iPLr y gC10L 101-000-420-000 $45"00
VITIU.L7 13040FEE )L 10) i541C -419-(K) _ � ° $29,00
OCT 03 2001
OF LA QUINTA
CITY
- FINANCE D1PT.
1"JR,'-',4"0T;' L C01,7M:.Ft110, 1014''r AND I?J:.AM f1 CK
`1;39:3.4Jt2
3.'4;x. .7�7.• 1111aL4.'Y,Y.0 S,� YE A.C3.0��t'�y:d"�4.4'9'S'
- R
,
RECEIPT DATEEE? % BY DATE FINALED INSP
TOR ,
rF
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
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Footings
Electric Bond
Main Drain
IOG
47—F-1- �V
Bond Beam
Approval to Cover
Equipment Location
•
Underground Electric
Final
Underground Plbg. Test
Gas
/y
Piping
PLUMBING APPROVALS
Gas Test
r 1"
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low V(Lage Wiring
Fixtureh
Main ervice
Sub ranels
Exterior Receptacles
G"F"I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)