9906-101 (RPL)LICENSED CONTRACTOR DECLARATION '
U) I hereby affirm under penalty of perjury that I am licensed under provisions of,
_ ;r`Chapter 9 (commencing with Section 7000) of Division 3 of the Business and.
C14 W Professionals Code, and my License is in full force and effect.
O=)M -� License # Lic. Class s Exp. Date
r --Cl LO 65b12 C_3 .. 4 10131i2iX
oZ 19 ta' a �Z f Signature of Contractor
o. ti
U
OWNER -BUILDER DECL�ARA II&
WW I hereby affirm under penalty of perjury that II am exempt from the Contractor's
U) License Law for the following reason: r'
Z_ ( ) 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).
ce) () I am exempt under Section , B&P.C. for this reason
In
N Date Signature of Owner
pN
U Q 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:
Carver Policy No.
STATEFUND 0116-19C11-000616011
(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 sh II forthwith comply with t ose provis d s.
ate: / � 1 Applicant y
Warning: Failure to secure Workers Com 1 sation coverage is unlawful and
shall subject an employer to crim n I 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, 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' spection purposes. /
Signature (Owner/Agent) f� ��/�' •; Date I 11/ j / 4
BUILDING PERMIT PERMITq
r
994.6'•1(I.l.
DATE' frFi%73/yljEdVALUATION S14_30%1.0t), LOT TRACT
r
JOB SITE r '
ADDRESS �aD g�'k�Pfl.lw.@
APN — —
OWNER
CONTRACTOR/DESIGNER/ENGINEER
wAPd"Th .:'1s..C"5f'1 11' _V
Ct1LI C.�i`:T�L �'t'C:,S c� SPAS
4100 WIAC AKl"1-:CUR'B.LVD #200
74-725 7L1;NI DRIVE�,'#A,
NI_WP()IZT t31?AO ' CA .42660
PALM O1?5t"IRT CA 92260
(760)340-9000 CBL4 35;
USE OF PERMIT
MOL .ANL1;0k SPA
POOL, SPA. & B130 C1T+tLY • ALAIMWBARWERS &RAL'L BE -IN PLACM AT
POOL Mg)lIOR 1111F.A K300.00 LS
E13111RUMD COST OF CONSTRUMON'
I,AN CHEf;'K.! .qtr 109-000-439-318 $.i.OS,3t7
1`113 -SpJ1V.ICAL, FrM -• 1'0101, n 000-X2.1.-OUft "7r7,G�3
q
0.::03: ',TRXAL 1'E.'C — POOL,
t'r9.f1lYf}3YNG F'EF, KKA, 101-000-4,19.000 SzV.00
° w rz:r.,rapu�aclrkr7r��v
LESS PI 1'.1.11.9 FFES
.0.00
JUN 211999
TM*M, PFORMIT Fs IFN DUE NOW
� �r
Z1iY ®F QUINT.
RECEIPT
DATE i
BY /
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms 8 Footings
Slab Grade
Steel
Roof Deck
OX to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Plumbing Top Out
Equipment Location
Shower Pans
Underground Electric
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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice
Final
COMMENTS:
CLo