9908-088 (RPL)c• r LICENSED CONTRACTOR DECLARATION
-d hereby'affirm under penalty of perjury.that I am licensed under provisions of
.Chapter 9 (commencing'with Section 1000) of Division 3 of`the Business and
Professionals Code, and my License is in full force and effect.
License # Lic: Class M Exp; Date690645•
pate r! '�` ' �� Signature of_ Contractor "^w^�•
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following' Beason:
( ) .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).
( ). l,.as owner of the property, am .exclusively contracting with, licensed
contractors to construct the project (Sec. x7044,. Business &, Professionals
Code).
O I am exempt under Section &P.C. for this.reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION .;
I hereby. affirm under penalty of perjury one of the following_•declajations:
( have and will maintain.a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700.of the Lador 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 STKfEFill�iD Policy No... 0.t5�98«I230•
(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 Kot employ any person in any manner so. as to become subject to.the
wor ers' compensation laws of California; andagree''that if I should become
sybject,,to the workers' compensation pro4isions'of•S6ction:3700of.the Labor
9ode .I,shall`forthawith comply with•tho e provisioW.r a,,. `
WDate. ' :f C. Applicant2i.RB: �;
Warning:. Failure to secure Workers' Compensation coverage is unlawful and
shall,subject anemployerto criminal *penalties and civil fines up.to $100,000;.in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety -
for
for, a permit subjectto the conditions and, restrictions set forth. on his
application.
1: Each_person•upon whose behalf this application is made & each person at
whose request and, for,whose benefit work is performed under or pursuant to
any permit issued as a result of -this applicaton agrees to, &' shall, .indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application_ becomes null and void if
work.is not commenced within 180 daysfrom.date•of issuance of :such
permit, or cessation.of work for 180 days will subject permit to'cancellation'.
I certify that I have read this application and, state that the above information is
correct. I agree•to'comply with all City, .and -State laws relating •to.the building
construction, and hereby authorize -,representatives of this.City to enter upon
the above-mentioned property for inspectionpurposes
/�
1,Signature. (Owner/Agent) _ Date
BUILDING
PERMIT # ;
PERMIT. -
DATE/ VALUATION, • .l�ar LOT• TRACT
JOB SITE 7q. -M® TORCi.I JA
APN — —
ADDRESS
a
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RiT HOW.S LLC ."
PLIT ItvfVi'S"k'NIE �°5; INC.
-
PO BOX 810
1425 E, M1FvTR9ff T D.RY.VE
LA171(N @A
CA 9253
PHlaF?i AZ
8_50,34
(602)25'7.16M c319[.4
4990.
USE OF PERMIT
VOOL APIa: OR. SPA
&V1&VA 10154A.. T -
1Pl2,1:�,•'fxLAS'k�..3i I1�1.SPiiC."�'iUN
;
IDOL, AND OR SQA.
EST ATE -111, CO2ff OF CONS R$fCif'ION '
o.
10,o0q.00
PERHIT FET SUMMARY
-
PL,A,N C�.� K FhF '
. '�(Yi.� t' f0�39• �]6. X76,03
C`O NSTRiT("'.Ci(N FW1
101-00041,9.0.00 �$l.l7.t►0
WXMNICAL FIM -- POOL
10,11-000421-000 x•23-000 SiX00
0.:FC�'MC AL FER -- F001,
.: l01 -4W. 420-040 �a15.oti
PL 3tu4i3iz+it-�.PtX3i' ''
tol-4.00--119-000. Q 7flr7
SIL178 '1"0T.M:.-CONS'I':i UC,°nON AND PLAN cFLcr_ .
.$2,99.05
LESS PRE.PAM MS
50.00
TOTAL .PERMff FEES WMNO W
$289.05
RECEIPT
DATE.
BY 1
DATE FINALED
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.
s Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
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
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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)