0204-172 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of. o
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
CI -51 to 123 C53 DIC C-8 I or I/oil
Date Signature of Contractor,^ r
OWNER-BUILDERtDECLAI#ATIO`
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
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.
�� 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:
Carder V'FAJJ E GIoMpENS Tl Policy No.
(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. manrer so as to become subject to the
workers' compensation laws of California;'and,agree'that if I should become
subject•.to the workers' compensation pmVisioris of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: AoDlicant', `
'Warning: Failure / to secure Wdrk `s' Compei4'sati";r)�c�"ov�rrage is unlawful and
shall subject�an°6mploye�ao crirri�penalfies an civil fines up to $100,000, in
addition to the cost of.compensat&on, damages as'provided for in Section 3706
of: the Labor Code, interest=:and attorneys fees.;
IMPORTANT Application i's,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 applicationis 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 authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) /7 Date
77 1
PERMIT#
-t)" =' BUILDING PERMIT
6204-472
DATE
I ✓�� VALUATION�ea� LOT TRACT
.�f
«
JOB SITE
ADDRESS W-9131! SWARMBA`s
APN
OWNER
CONTRACTOR / DESIGNER / EN &NEER
C"nI`4.".tom: vEite lts
r."°.A1..:&V)R tA P001,8 & SPAR ('COP WN CO
22R.0 WAi1DWW MCJIA SUM 130
74 i 25 10NI DIUVISo SUM 0A
CORONA. CA 91720
PpJatA DUE= CA 92260
(760)340-9000 QUO08355
USE OF PERMIT
POOL ANDD fR 13PA.
PC7t- L AND SPA aNL.Yr OAS UN FUTURE 88g ANSI 221.58.1993.
AkARWRAMERS SHALL LIAPIA.eKPRIOR 1OIRT€LAUFA,
i13nnE4AyyON. MTOL 9QUIPY•&VT 9MC.0SURENOT WCLUDEU I?- PERMIT.
POM ANi DOR JPA i ;Bt O.tlt1 Z>9
XT.W49M COSY OF COMHUC'MW
PIAS H Cfly4K 1472 101.4 39.318 SINAI
CONSTRUCTION FIM, 101-000.4.18-.000 $189.00
MECHANICAL F — POOL, 101-000-421-000 21000 $24;00
P.UPC'TPJr,AL FEE — POOL 101-000-420-E700 $45.00
1'FstlMBINGt R&F, -- POOL. 101-000-419-000
I,WA� tiC11ON AND T?I. AI•i CHROX.�fJ?.f3S
_U LES: 1P ak''�1I.I�:I��S
$0.00
D U
L 1'IMT FEES Ci NOW
Vi!'f
APR 24 2002
CRYOFLAQUIWA
FINANCEDEPT.
fti
RECEIPT
DATE
/
BY
D FINAL
INSP R
ti.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
I 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
i 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
i
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
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
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: