0007-190 (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
Professionalstode, and my License is in full",force and effect. ..
License ## Lia Class Exp. Date
ateSignature 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);
O 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,
orkers„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:
CarrierPolicy No.
S7'ATL i1J2d1�-.. 7Z
229 0�-001g33d
(This section need not be completed if the permit "valuation is .for $100.00 or]essy
() 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 e wor'ers' compensation provsio s of Section .3700 of the Labor
Code,, s dwith comply-withetihoov 1JEvislons. ,,•„
/Date:�� Applicant=
Warning: Failure to secure Workers' Compensation coverage*is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.`
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth • on his
application.
1. Each person upon whose behalf this application is made &. each person at
whose request and for whose benefit work is, performed under or pursuant.to
any permit issued as a result of this applicaton agrees to, &. shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null'and void if
work is not commenced within 180 days_ from date_ of. issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
Correct. I agree to comply with all City, and, State -laws 'relating to.the building
construction, and hereby authoriz�ewesentatives of this City to enter upon
the/above-mentioned props y fo�,pection,'oses.gnature (Owner/Agent)Date
f el' i
U BUILDING PERMIT'..PERMIT#
DATE VALUATION A LOT QW7-190 TRACT
JOB SITE APN
ADDRESS 64-*" WANDia DAY
OWNER CONTRACTOR/DESIGNER/EN 1NEER-
CEN1 HOMIES TIAL HAWTON tibe VM AT1 N POOLS
280 WARIDLOW CIiZCT�-F� Surm 150 9522 DONAWSOO RD,
CORONA CA 91720 V(X--'F..12NEVALLEY CA. 92356
s;9R)24F-t 04? CBVf 4335
USE OF PERMIT
POOL AND/OR SPA
P004 & SFA ONLY -AI: ATUASWAIMti S SHALL BE IN PL.A.grl, IN AT
PIR&PLASTER INSPIICTIOM
VALUATION
151000.00 is
Ii±:,S'i',13vW11W COSY' at Cwwnucril'ow
PLM CHECK FEE 101.000439ii518 SI0�,30
CONSTRUCTION I= 101-000-11$-000 $162.00
MECHANICAL FEE -- POOL, 101-000-1421.000 $24.00
ELECTRICAL PER -• POOL 101-000-420-000 $45.00
PL UMBINO FEE -- POOL, 101.000.419-000 $27,00
SUIS -TOTAL, CON MUMIE N' AVIDI P1..,AN CkIIC:l
LASS PRE -PAID PM
RECEIPT I DATE
TOT&LIP-10MITUr:fib 101E NOW
J-51 )m
$363.:x0
$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
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
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric AP
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
i
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exteitor Receptacles
G.F.r
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: