0112-044 (RPL) (2)r� `�' LICENSED CONTRACTOR DECLARATION
I hereby aff rm`urider penalty of perjury that I am licensed under provisions of
Chapter9 (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
48.3498 CS 3
Date -I%fY Signature of Contractor/ -^Y? -� ' /-"
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 Z i..AyA i 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:
Carrier 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 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�those provisions.
Dateh p' APPlicant 4.111J
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 condltlons 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 authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
143ignature (Owner/Agent) f '12;-4f Date "'—e
t
w
-' BUMMING PERMIT PERMITk
DATE VALUATION—,, LOCA SSSS TRACT
JOB SITE
APN r
ADDRESS i-,.'Y2Ct TAN GH.Y` WOOD
- -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
08 4706 le0tM klW DRIVE
', C>, O 1.524
M 0=6 ALBERTA LA. °1°4MI.MA
PALM DMIMT CA 92261
('76))568- 963 CRL4 725
USE OF PERMIT
t"
OM ANDJOR SPA
Pf;7MAM ALAReMSf3A"1=1' S1i. .L BE IN PLACE AT F •PLASTFR
1"rYS�'P,s,T'�st�kb, �E201.,.I?G1YiYPR,�?'k�T t�7�t';i:,t�t�f3�ti7.�t4)`i' il.'dCi.tJI��Y.�.
POOL A@iW(M. SPA 2I.QM00 LS
3
PL414 CHECK NR 101-000-439-318 S134M
E*;C'NS7'Fii.YS;3.'IM fUZ 101 -OW -418-000 $2010
WORANICAL &'FIR __ Pool, 101-000-421-000 S.z4,00
TE.3.1XT9t.'ICAI.. t+EY✓ — PML 1011-000-420,000 so.00
P). M81HO "1�1r .- POOL WI -600-419-000
tDFC 0 7 2001
CITYOFLALBUI� A.
:-, o.Tr~IMON AwD PY.A31' �` ..t,�
$437,51
1YZrJ1�IZF'�.P.Pm FT05
$0.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
/. el a• ' t. %
j 4
.
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
BLOCKWALL APPROVALS
steel
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
Gas Test
COMMENTS:
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
POOLS -SPAS