0007-188 (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 Inies a is in full force and effect.
License # Lic. Class. Exp. Date .
351673 C53 01131/2(
X.,
U4ate 'I% _1 _7 nature 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:
1, 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).
( ) 1, as owner of the property, am exclusively contracting, with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Co * de).
I am exempt under Section B&P.G. 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'
s'
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 , STANE FUND Policy No
329.00.0019339 .
(This section need not. becompleted if the'pe.rmit. valuation is for, $100.00 or less).
I certify that in the performance of the:workfor which this permit is iss'ued,
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, Dae
I Shay forthwith comply with those �r Islons.
-0 /--Annlir..qnt 07
✓
Warning. Failure to secure Workers' �,ompen/sqa ion coverage is unlawful and
shall subject an employer to criminal penalties andcivil fines up to $100,000, in
addition to the cost of compensation,. dama&s'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 un,d6r or pursuant to
any permit issued as a result of this appliceiton,agrees.to, &- shall, indemnify
& hold harmless the City of La Quinta, its officers,'agerits-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 la%ks relating to the building
construction, and hereby authorize representatives of this City to, enter upon
1 .1
the above-mentioned property for inspection purposes.
ignature' (Owner/Agent�J Dat'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE APN
ADDRESS m4si swjkw r
jumv I
1
OWNER CONTRACTOR / DESIGNER /J EN (NEER
'A RAL HAWITON dba VACM014 POOLS
2280 WARDLOW CIRCLE, SWUM 0 9,522DO14ALDSON RD,
COR014A CA W120 1XIM2:C+1•J3 VA CA 92356
(909)2496045 IUSIA 4335
USE OF PERMIT
FOOL ANDINR VA
POOL a- SPA OWLY-A1.ARMMAMJ_PRS SHALL B.9 IN PiAuz IN AT
PMPLAMR 1143PWTION.
VALUATION I 15,000, 00 Ls
MB -TMA L CONWRUCIION AWD PI" CRIXX
7.3 S9 YP%_P.1kM MIS
MULL ry, Im. rr ms 1) ur mw
RECEIPT DATE I BY//, L_N _ DATE FINALED INSPECTOR
151000,0D
$363.30
$0,00
i.
r. IMIAWM COST OF C010TRUCTITOR
PERMT, ro RE 9UMMARY
PLAN CHWX M,
101.000-459-318
$105,30
CONSTRUCTION ME
101-000-418-000
MCHANT(ML M--- POOL
101-000.421-000
S24.00
ELWTRICAL FEE ao POOL
101.1100-420.000
$43.00
PLUMPINO ME POOL
101.000-419-000
$27,00
MB -TMA L CONWRUCIION AWD PI" CRIXX
7.3 S9 YP%_P.1kM MIS
MULL ry, Im. rr ms 1) ur mw
RECEIPT DATE I BY//, L_N _ DATE FINALED INSPECTOR
151000,0D
$363.30
$0,00
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
og to Wrap
F.A.U.
Framing
Compressor
.. sulation
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
POOLS - SPAS
Steel
Set Backs
Electric Bond 0/07 A14-1
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
Neater 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: