0004-154 (RPL)\4 j LICENSED CONTRACTOR DECLARATION
I hei;;by affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9.(commencing with Section 7000) of Division 3 of the Business and
LU
Plofe:�sionals Code, and my License is in full force and effect.
in =) m License # Lic. Class Exp., Date
766410 B 05131/2(
DaieL -- Signature of Contra6Wb - N .,� /.._—._9..__
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 theproperty, 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:,
Cartier Policy No.
ZENITH INSURANCE 7.042062504
(This section need not be completed it 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/l'shall forthwith comply with those provisions.
Dat :G Applicant
arning: 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, 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.
Signature
(Owner/Agent) ✓ �1 DatUL—J-2-0-1-11,
BUILDING PERMIT PERMIT"
DATE VALUATION LOT 0004-3.54 TRACT
JOB SOE`71/
/
APN
ADDRESS))
7'� ONE FAZIIO LANE WORM
- -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MCWTYRE POOLS & SP
TURPIN CONSTRUC'TiOt�I 00. - t
P.O. BOX 1797
78-120 CALL=ADO 0206 .
LA QUINTA CA 92233
LA QUINTA CA 92253,
(740)777-'76'11 CBL# 3751
+
USE OF PERMIT
POOL AND/OR SPA
POOL & SPA ONLY-•ALARMSfOARWERS SHALL BE IN PL&CE AT PRE
PLASTER INSPECTION =•
PCOLA.NDIOR SPA 15,000.001.3
)EsTn"'iED COST OF COWSTIZUMON
15, 1.00
Pyr FEE SUtSO4ARY
PIAN cli9e C FEE 101.000.439-318 $105.30
CONSTRUCTION FEE 101-000-418-000 $162.00
MECHANICAL FF.F .- POOL 101-000-421-000 $24.00
ELECTRICAL.' FEE-- POOL 101-000-420-000 $43.00
PLUNISIM FEE --POOL 101-000-4.19.000 $77.00
SUR -TOTAL CONSMUCTION AND PLAN CHECK
$.163.30
LESS PRE -PAID 17ES
$0.00
TOTAL k MP&. T IrkTI N DIE NOW
X3:30
RECEIPT
DATE
BY "\ <
to
-DAT F L `_
INSPECTOR
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
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
_ cv
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
25;r-1
Underground Electric
-? !.v
Underground Plbg. Test
e2 7
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
%v
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
�
COMMENTS:
s�
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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