0102-082 (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 Exp. Date
6175 C53
Dated Signature of Contractors'
- OWNER= BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
C ) 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.
ave ,and will maintain workers' compensation insurance, as required by
SectioW3700 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.
STATE IBL)
(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 shouldtbecome
j subject to the workers' compensatign provisions of Secti n 700 of t, ie Labor
Code, I shall forthwith comply with o e provrsi ns
"'Date: Applicant
Warning: Failure to secure Workers' Compensat on coverage is unlawful and
shall subject an employer to criminal penalties and civil;'fines up o $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.. i
IMPORTANT Application is hereby made to the Director of Building and Safety_
for a permit subject to the conditions and restrictions set forth on hi%.
application. aip� r
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 perm'W.Jo 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 authgr'ze representatives of this City to enter upon
the above-mentioned property o insp ctiol pur oges.
-Signature (Owner/Agent) ;l Date2 `?--t)f
+ t
BUILDING PERMIT PERMT# qqq
DATE -- Y tiM1VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
7:1 SPT BAY
- -
OWNER
CONTRACTOR / DESIGNER / EN INEER
WAiOVKTIVE RESORT 1CO fi.TJRMEWC:.
C'.AURAITV,. POOLS & SPAS
200 RWAMT-MG a 100
74.723 j0N1 DME,14A
iiC(7Af3 � CA 92025
PAIL M DFSMR-T CA 9.2260
C76(a5340.9000 0SLOA 5386
USE OF PERMIT
POOL•MiXOR S'PA
POOL, & SPA 07VI..Y-A1:,ARMVk3M'AJit,'RS Sii.;4LL UR IN PI,4C1.1 AT FEV,
PC,,ASYRR INSPECTIOWPOOL UQUIPME'"4• T L�` * CV2URI? IN NOT INC:i:(tMM
MTHIS PERMIT
FOOL ANWOR tiPA LS
I IAH CHECK FES, l i1I - n439-318 $ 4.53
CONSTRUCTION N t+'S.E 101-000-418-000 $20-00
MCK4tIUCAL FXr -- POOL, I0I.000-41•21.000 $24.00
ITLE I'A1t'AL PEf> „� POOL, 101-000-420-000 $43.00
P€.IJ MPITNO FOS -- PWO ! 01 -OW-419-000 $27.00
b
yr ;
FEB 1
'a�9�
4 MTS TMAL COMMMM04AIM PLAN MU
$417.55
%M19 PRE -P =It,)
$0,00
`i 1;751,344 J?XTfli f' 1y,T= !L• UE -K.OW
$437M
M
G
's
i
c~
RECEIPT
DATEY
BY {F�"w�
%
DATE FINALED
INSPECTOR
a
-7
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
PLUMBING APPROVALS
Gas Piping
Gas Test
Electric Final
_
Z
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
Utility
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)
Final
COMMENTS: