0208-158 (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.
LicenseC# C-53
tLic. `Class Exp. Date, �r ter
51574•.2 C-5 3 Id>f3 i%3:
Da..te + .r-
�� ��'r't1 Signature of Contractor !� . � • j _ � • �•- %
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.
v(,) 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 6T.A`'Z;rq;1J13 Policy No. 103480341
(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.; ✓j
Date: I �, , ,l.�:a Applicant .J,�i. L . ,; ?..�.
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 under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& 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.
r
Signature (Owner/Agent,/1. % A t f r'�' Date
r .�.., .�.,, ., r
-fBUILDING PERMIT PERMIT #�
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS ,f3-614 J�dt`'F:+CXA C OTY
APN F r
OWNER
CONTRACTOR/DESIGNER/EN (NEER
)SWlx & SH.A,1�3'M MARGE
AWERWAN POOL CON1a`1TWC'.'LIt1N
43.0074 VERONACOURr
'739601UGIMAY.'111
LA QXM4TA CA 92253
PATI -A �?F,hyc''C.v"'�..0 CA 92255-1
C160)340.2588 C B1,4 .1104
USE OF PERMIT
FO("a1. AMOR SPA.
POL9,'La' M ,AL.A.RPAWSA.MOIEW aSH.ALL 11E IN PL ACIE .AT .PRE•PI AZTEM
INSPWT:ON, EQUIPMENT ENK:'IFi)3d1NW,NOT 1NMt D&D.
FOOL ANDIOR JPA YA
E�'MUTIM COITIF CJS' C01 11RU ' IZOi�T
..� .
d`,q ',}� 97(� g 'i�� �c��"7 _(y�y� (�':t
Y-71iYKM A%9r11v.. l7@liH•AEli ARY
PLAN CHBOX _' 101.000-439.318 0140.40
CCINM'1e:l3tu t ION 1PRE. 101.000-41€1-000 016.00
ECHA'RSIGAL T r R -- POOL 1.01.000-421-000 $24,00
EUIPC. t RICAL .PEE — POOL 101- ^420-000 $45.00
NI.,llMBIN0.7a P 3t;JL 101000.419«000 $27.00
_D r iiAb.�C�NT�sI " "x(51 A'leD KAX CREC"K
$432.40
MS RRR-PAW 04EN
RIM
AE!f; 1 4 24 . � o
AO
CITY OF LAQUINTA r _.. ,•
FINANCE OEF'4
RECEIPT
DATE j
BY i ___[FAq
FIIJALEQ
SPECTOR
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
Gas Test
Electric Final
nnremli _ Int I ath
Waste Lines
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
%D _ oZ
Set Backs
Electric Bond
Footings
Main Drain
DB2
Bond Beam
Approval to Cover
— lj
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
111� C^S
Gas Pioino
I Final
I ELECTRICAL APPROVALS
Temp. Power Pole
Fixtures
Main Service
Sub Panels
Exterior Receptac
G.F.I.
Smoke Detectors
Temp. Use of Pa
I Final
Final
COMMENTS:
ISI
LU
NOTES:
^m
r
ALL-LaiLi�L(�L1.5-
`�•.�?Ie�b}�
%
jLL-.
rK
L.r1/.
a
PA r r<MJtEC ? 2'-L4"-ZP
� Ylir. hAiltC(•.�fII.�F'�in r�li',T/,5J!
pQ
co
r
^ 3" FOR
Ln
AREA MAP
r
C
Icy MAP NO. Yprr
c.
p
Ix
Cvi
�a
F,c,�TiLir
ill'c�r.rfE aP
•
•
-
i
7pr...p �s
j1
W
S�
�
ems"
U
Am
�I`� C -Cr IhC�l�usr}
Z
s�r,h,
��
tCFRCF—
LIC.*` 51874
ccl
cri
IiJAo E ft arJAEr?
NAMES r
vf' P'dJ k
F•-
_
A EJrr ,IfA ,l R 42253
i Il
I
i
- 1'
a
_1
lOT El OC7c SEC•
PPCPERTY LNE
UTLAY POLE&NCTION
Q
WX
HOSE
UcDiAs
LEj}L'4Z; VF
cri
__.__. -- UTUTY EASEMIEHT
(�f ELEC PANEL
0^8
00hlER
- FLL LVE
�1 ltCfiT
AREA DRAIN
n AACUICAN
VVUL
M
FBCE fHErWT,TYPE
O WS METER
V
WTFA L
FILTER TER
-+ ORRETURH
! PVC Uf:
M� CQV�T4{ICZION
—E—E-- UKDEAGFKXM ELEG---�
�7ElI WfbC
REMIQTE WLVE
Q MfATER
Tt�y
� GP48 RAILS
I
3'Jz
p Q. B(�x �I as
�
ELM®UaTER
DEPTHGATEV1lVE
�$j ww URAL+
-. AERATOR
� UDDER
GAS �L
3' �
PALM RT CA.
(�'�
N
-
prEPIAD TELE.
"^'T/
SCl1
® P TRAP
6 ��
QDANDER
SEE NOTES
(760) 340-2$88
ELEC PEDESTAL
pp�S�
ABCEPTACLE
� STUB
ty
I
I
Ijl
Co
ry
^/
I
co
�