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0202-146 (RPL)l LICENSED CONTRACTOR DECLARATION •1 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 y 18742 C-53 1 10131 AX Date . /- Signature of Contractor, �{1 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 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 mn Patin Policy No. 1!93480301 (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 provi'sions!.. Date:Applicant t f Warning: Failure to secure Workers' Compensation coverage is unlawful:r' shall subject an employer to criminal penalties and civilfinesup to $100,00r addition to the cost of compensation, damages as provided for in Section of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Sa e y for a permit subject to the conditions and restrictions set forth on is application. 1. Each person upon whose behalf this application is made &each perso 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.t 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) �, ! / Date 6' BUILDING PERMIT DATE iVALUATION LOT 0�'^Q? TRACT JOB SITE' APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER JAW F0 SIM! POOT, C0)sT-KM13'CY1038 79-62.0 MADWS1, 73961D IUGHi AY -111 _. T.AQWNT,A� CA 42233 PALM DEWER.0 i':A 922,55-45 "� 0j34t1�2 a I!=* 1104 USE OF PERMIT POOL ANDIM VA, POOL, AND SPA, ONLY. AL M IOARR11'.RS SHALL 01t W PLACE PWOR TO PR,EP)ARrt' R OISPL+C°TION. POOL &QUIPMENT 1?Nt:i.OWRE NOT I2d4:l..I DED 114 PERMIT, POOL ADIOR. SPA L,S ESIM;�,IM COST OF CONSI'ktCiCTION 2s&,'`3 y :>,i�mffil YEE 14TH "Ry PLAN C:S1W%iU CON 511T UICTION K?E to 1-000,4 t o %130 $93.00 MECHANICAL t`!t~:�--FOOL 1431.000.421.000 $24,00 GPLECTIILICAt FU — PS1aL 101.000-420-0410 545.00 _ 101 -0 00.419-000 PLtlMB,l'A O PRE • POOL 9.000 , ti q TMAR02002 1 1i CO'rY0FLAQUIWA RMAKFUM 'STT -TfY.!',A,L, COQ$STMUCM0,14 AW) PLI.NX CITEM! S�✓1�8�.�3 LESS PRS -PAM FRES $Q.00 O AL Mom 2C S'e 'ek2 DOR. now YF ��.Yi!a:✓'� RECEIPT DATE BY DATE FINALED INSPECTOR err.-( 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 Wali Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS Steel POOLS - SPAS 3 _ Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover 00,_ Equipment Location _ Underground Electric Underground Plbg. Test Final 1 Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Shower Pans Equipment Enclosure O.K. for Finish Plaster P7:Wz� 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 Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 4 vAe (2) SIE25 O'D ,FRS 111 i llI � C \�--J ' AREA MAP ilus* 51874 CD rr , r NAhE �OA7 f UIri.S�b �S lF�. � 40E�, �O IzAl 0,C -910.SA41(tfE[L Cry¢, LO _ADDR-�Lll- LAGi u nv#+ r CA LOT 2 z BLuCx �c m _ PROPERTY LIE © UTILITY POLE JQ .A.WCTDN BOX ►osE BeB8 DECK043 W+ TEL£ w TE R != iy 2 _ U?LrTY EASEMENT OE ELEC K EL e B.D*ER - FLL LINE B LJB"T AREA DRAIN�. 'e,DR .jM�I21C�N MM FENCE (FEGHT,TYPEI GAS uETEit' O 1YriFA LEVELER OF FUER RETIJW =_= PVC MAIN �r 1;USML11icT11W C4 —E—E— UNDERGROUND ELEC. —G—G— UNDERGROUND c,As � BENQ( k AW 1� RELOTE WkLVE � I#ATER GRAB RALS ars' --- P 0.80 11996 x - - pVERFf AD ELEC. T� OEM � GATE wLVE �D MAIN ORM -� A FRATOR � LADDER 3Y 5 ---- PA U�S DACA -Rj @- OWJ*V-►D TELE. RA = swrrpt ' P Tw►p a Pump ti �LL r (760) 340-2588 ® ELEC PEDESTAL. ACCESS� RECEPTACLE --B STUB d QA ANDUR SEE NOTES .- � NOTES: 4 aC 4- z' - D AppRO S `• . ITy O� LA QUINTA- 3 C 13 q i° BUI DING & SAFETY DEPT. pPoROVED gyz ; • r • OR CONSTFRUCTION 0 �a� `—_ (2)S AREA MAP KEY No. pE-INSPECTION VEE Of VED A gE CHARGED If THE APPRO OT ONAND 308 CARD A�HEDULED SITE FUR A S GUN �,r��� � - • - • IC. 51874 . { 1 NAME l OrY1 �L nr. i5fi ES ITS L--ry CE - �► t- t Mi Ug� j' - 0• LOT 2 L BLOCK r SEG t 23S�-S ---. PROPERTY LIME OU UTILITY POLE J� a�1CTpN BOX ®HOSE BIB q4 .SKI NCR '� OECIDRAIN TELF. w - PFa�PE AREDRAIN . AMI? 1 CAN -- --- --- UTILITY EASEMENT OE ELEC. PANEL OB BLOWER -- FILL LINE ��� LST `� --�--�— FENCE (HEIGHT, TYPE) O GAS METER- 0 VATER LEVELER OF FILTER —+, DR•RETURN __= PvC DRAM uNDERC41OUND ELEC. BENCH MARC &RE-MOTE WLVE H� HEATER + THERAPY = c�AB RAILS _ P 0. BOX 11996 —G—G— UNDERGROUND GAS 3YL' �v OVERHEAD ELEC. WATER DEPTH ® GATE .VALVE Op MAIN DRAIN -♦ AERATOR � LADDER 3y 5 � PALM DESERT CA. O GAS GRILL --�-�— OVERHEAD TELE. RAW = SWITCH ©P TRAP a PtA�P (760) 340-2588 ® b CUP SEE NOTES ELEC. PEDESTAL, ACCESSC* 0 RECEPTACLE --3 STUB