9802-147 (RPL)F�—
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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 Exp. Date
Date, 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 (See. 7044, Business & Professionals
Code).
(') I am ex.�/ �t,urber Section , B&P.,GA is�reason
.�' , Gem = '--.,._.....-.. —
Date / 4 -;:/Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) 1 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.
( ) 1 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:
Cartier Policy No.
t<t:;LL�Eiv-AGLE IUS. NWC 2,12i9i t)
(This section need note 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 sbyl forEhwith comply with4bQse�rQv_isionS.
Date: .� _24' - 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 employed.,'
2. Any permit issued as a result of this application becomes null and voidf
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
theabove-mentioned property
Signature (Owner/Agent) Date
UILDINGPERMIT PERMITar CONTROI'g
DATE j.•� J VALUATION LOT "02-147 TRACT
i
$11,732.00 22 1:19 i. yJ l 11-
JOB SITE
APN
ADDRESS
5XS60 AVEN1DA COI1.7'EZ
774-102-003
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ESEQUIEL 1v1 CORONEL
CORONEL Ct�NSTft1.1+"- tION
PO BOX 3FO,
P.0, BOX 389
LA QU1N-rA CA 92253
LA QUINTA CA 92253
(750)564-4604 (f'BL# x'201
USE OF PERMIT
POOL AND 81) L.1:., V O.A't2dEiv WALL; CITY STAMDARD.
POOL ANDI.']'iR SPA 10,000.00 LS
5.FT. WALL 1311.00 LP
ESTIMA" 14M COST O€' CONSTRUCTION
11,7:32.091
PERMIT FEE SUMMARY
PLAN CHECK FEE 101-100-439-318 176,05
CONSTRUCTION NEE 101-000-418-M $158,00
ELECTRICAL FT -,E -- POOL 101-000-120-000 $45.00
PLUIVIBI NO FEE •- POOL 101 -WO -419-000 $27114f
.y
SUB -TOTAL C'ONSSTRUCnON AND PLAN CHECK
5306.05
LLSS PIU,.-PAID1-,*FI.,S
$0.tx)
MAR 3 1998
t� �TOTAII, PERMIT FEES DOTE NOW
$306.05
Qor-®�9
CITY 1� V
1'
RECEIPT
DATE
BY lI
. j
DATE FINALED
INSPECTOR
INSPECTIt�N RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BMMMG APPROVALS
MECHAMCAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
FA.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
SLOCKWALL APPROVALS
Steel
POOLS a SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam AOW, 5vflffApproval
to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
/ Ad
Final
Gas Piping
PL4.DMMMG APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
0. K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTMCAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lown Voltage Wiring
Fudures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
-L�6nal
n sry Notice (Perm)
COMMENTS: