0103-042 (RPL)Y. V LICENSED CONTRACTOR DECLARATION
I h�er�e by firm 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 III full fulce a Id effeuI.
License # Lic. Class ! E I6. Qad
.Signature of Contract(
OWNER -BUDDER D
I hereby, affirm under penalty. of p(:,jury thdFI"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 " Policy No.
STATE, FUND 103430-00
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of the w r� for 0ich this permit is issued,
I shall not employ any person -in -any ane AD a�sefo become subject to the
workers' compensation -.166; of California, a''id airce that if I should become
subject to the'.,workerscompensation o4Iision�s%VSection 3700 of the Labor
Code, I:,s iall,fQrthwith, comply with, th_o, pvisjon�.
Warning: Failure to`secure Workers? Compensation coverage is unlawful and
shall subject an employe crimiri I penaltiend civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.'.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for, 1,80-dgys will subject permit to cancellation.
I certify that I have read this;.application and stateo hat the above information is
correct. I agree to comply with all City, �arnij,St te�.Wvs relating to the building
construction, and herebyLauthorize representati ves/of this City to enter upon
the above-mentioned property `for inspection puf rposes.
Signature (Owner/Agent) + f+ S Date A �,,1�,'
BUILDING PERMIT PERMIT#
j
DATE--,; ��e VALUATION LOT i ��+ -�� TRACT
1 '
JOB SITE
APN
ADDRESS
?..- '7GQ PAppfy0
OWNER
CONTRACTOR / DESIGNER / EN (NEER
19-9.2) OTAOr
73:��C►��iCt�l�Al?' 11�
LA Quffl`.£'A f-' A. 92253
PAL.TkSt ))M`RT ('A. 92253 -IS
(760)340-2568 C' LO, 1104
USE OF PERMIT
POOLAN3,XORAIEIA.
P00149PA. A1JM,451ZARTtiZP.S SHALL BF. IN .PE..ACI 13T TIME OF
PR&PL48TKR PAWRE-OTIM POOL VQUIP14 M T ENCLOSURE Molt
I1$i",Y.,I:lDRID.
POOL ANVOit.SPA L'
..Tim7117) fC*7 OF C7iGa7C110H
XOID<40
plianXI66i iyMMA'Ry
PLAN C13F4VK.1X . 10t-000-439-'.418 $184.93
C ONSTRi.1C'1 IbN tib 101-000.4,18-000
TAEC ANUCh`L P77. — POOL 101n000-421.000 $24,00
B E1:TRY.",AL k „ POOL 1014100-420-000 $4.5,03
« PIAT.101YdO1'EY P00111 101 -M10 -419 -WO $.717100
MAR 15 2001
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I..1+;SS PKE-PAW
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DAT
:A <
BY
DATE FINALED
INSPECTOR
r
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
t' 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
t
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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.i�!`
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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