0205-233 (RPL)U)
F_
U)
N LLI -
OCY
M
LLJ
OZt�
(Do O
H(0
w W '�
I— n.
Z
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
ODate y�'Y-" 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 (Sec. 7044, Business & Professionals
Code).
() I am -exempt under Section B&P.C. for this reason
Date Signature of Owner
t um', WORKER'S COMPENSATION DECLARATION
I hereby affirm4^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.
(Xf I have and will maintain workers' compensation insurance, as required by
S ction 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 RTAT1r COMI1 4SAY! Policy No. 046P06163-91
(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
Code, I shall forthwith comply with t ose provisions.
/-Date:1 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 uri.der or pursuant.to
any permit issued as a result of this applicaton agrees to, ,& shall, indemnify q
& 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 authorize representatives of this City to enter upon
the above-mentioned propertytfor ins ection urpossees. .
Signature (Owner/Agent)k I Date._ 2�`'
f
BUILDING PERMIT'PERMIT#
•DATEt**3 VALUATION LOT TRACTJOB SITE
ADDRESS 80.934 +�}°AMSH BAY APN
OWNER CONTRACTOR/DESIGNER/EN (NEER
UOTCi'�". IIV �� a� � �TvS�9:ziiai "l :1� '� - c'°AUOMiA POOLS SPAS CAD -MM CO
700 le. WAMM3Q°kONAVS', 0100 7,1325 J0141 EARIVE,. WME PA
LISCO1ANDO CA . 920325 PALM DESE - CA 91260
(76)M0-9000 i C: 114 00355 a
USE OF PERMIT
P001, ANDIOR 10"M
tr VI.&PPA. !'i%.P MNIS/I;.f4RRlMS SMAI..1:, Sit INt PLA.C&AT PaRZ :t?I.;AS'i`FP,
INSPECTION. P606 EQUIPM&UT 1? 11(r3U Y NOT 1144 ,.k DRD,
`V'AI..iAA'3ION
PLAN C*HECK MR9 5122,83
COWSTRUC:TIONFEE 101-00I.4,18-000 $489.00
M1iwC I"ICAL FEE POOL L ...101-0t 0,421a000 $24M
1ILF f'RICAL ft, ? — POOL z 7 )1-000- Z?A-000 ��15:1F0
PLUMBINa FEE P-00, 000,419-M10 MIN
QUINTA
.0 O EDEPT
n.
:�31-"I`OTAL C'U'��'?j C:1t1,TM.10A' AN1•;1:AL.FITT CIMCW
TOTAL MUMU "ITS 01%, NOW
RECEIPT DATE- .> L7 IN7
7N * �SyW
$40'7:95
$0.00
,97,WS
.■
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 F.A.U.
Framing
Compressor
Insulation
_ Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
t Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
6
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
Gas Piping
_
17
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Umllerground 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)