9911-046 (RPL)t r, t
`LICENSED CONTRACTOR DECLARATION , wJ 'f
I hereby affirm under,penalty of perjury that'I am licensed under provlslons�of
Cfiapte -�9 (60MIT1e67cing. wijh, Section 7000)" of Division 3 of the Business andl
Professionals Code, and my License isin full force and effect.
,License# Lic. Class Exp. Date
7216532 C 10 C�70 13 =31120(
Date /- =1211' Signature of Gontract'
OWNER-BUILDER.DECLAR TION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law forthe 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.
()o 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.
(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
Rode, I'shall forthwith comply with those voyisions.
ate7� 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
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.
i 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. l agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
thh above-mentioned property for inspection purposes.
7
VSignature (Owner/Agent,'�'� -� Date l';1�4V
PERMIT#
BUILDING PERMIT
99m6
TY:wt.f"4ta(I'
DATE a�VALUATION �,+FF�14 LOT b TRACTJOB
SITE
ADDRESS 50-900 SAti.rOiMACOURT
APN
J
:OWNER
CONTRACTOR / DESIGNER / ENGINEER i
�
,^UchIJ�?
GROUP
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,rY t 'r111117Y' Y STA7''SiIC�l1gb v
a.niu n �f.,.►.� - Y.l:v.a..4� d..
.P 0'Box 1.490J�33n0
AVENUE .�3, Ss,Jt?['L C
1.A V' UINI-A CA 92:153
Qi�t olo 'CA.
/I2-3368 ` CRY.,# 617
USE OF PERMIT
1".).L AN#.,iOR SPA,
P00L AND SPo.-OW 1'- ALARAOMMUQRS SHALL
PLA.S'IX.ft 1PI;lf'7.: TIUN
POOL Arr ' IIR SPA LS
� s a.NI x'�e+I'M +u 011? L,i°s•�rS ° 10 ` n ION
w»w ° «ii v�
PRRMI T FE TZ S,UJIMMAK r
PLAN CHECK: FEU, 101 -OW -439-318 �42i.�S3
:r3
('!f)TJ:C'['iz62rrl'➢�7� 1''l:rf� lot-44ijt?_�ff1 "$9p,gf5
_; s`"; .
R4LC'l I.W. 'N_ f 511"1.. _ IVX"JL 101 •000 4? 1-OOi)
P(JOL 1..01r06"20-000 &15.00
RLI. h4.P.FNU-FE>E 1014M-419-400 $270)
50
LESS P'12R'M-P1UD F IS
WOO
170°UAL P1?,P.MI'9' FX tJle, N0W,
$244,,556
i
RECEIPT
DATE
BY�
{j"I
f
DATEFINALED
INSPECTOR
.11i
INSPECTION RECORD
• OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings?
Ducts
Slab Grade I
Return Air
Steel i
Combustion Air -
Roof Deck I
Exhaust Fans
O.K. to Wrap I
F.A.U.
Framing
Compressor
Insulation i
Vents
Fireplace P.L. I
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
I
i
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs 1
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final i
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final •
Plumbing Top Out i
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral 1
Pool Cover
Sewer Connection ;
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
1
Final
• Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole 11
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures 7
Main Service i
Sub Panels
Exterior Receptacles j
G.H.
Smoke Detectors
Temp. Use of Power I
j
Final
Utility Notice (Perm)