0102-088 (MISC)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.
License # Lic. Class .yxp. Date
i' 741 *7 A �" � ;,..�r" f j 0813 t
Date : Signature of Contractor .y. r ^'`
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, Buslness & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Sianature 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 theWork 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 ?U41D
(Tfiis 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 th t, if I should become .
subject to the workers' compensation prow sions of Section 3700 of the Labor
Code, I shall forthwith comply with those, provisions 4
Dat -;� �' > Applicant 77/
Warning: Failure to secure Workers' Comp ensation 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 represe. atiV2svof.;thfis City to enter upon
the above-mentioned property for inspection purpose !
Signature (Owner/Agent)"!> r•- - ; Date f °�
..�" � '•' :...C"..'. .::. yrCr' "'`'•� ;,'- :ate G:r°
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
JOB SITE
APN
ADDRESS
4.54 1.5 SUMERAY MUM,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
A5.1 15gM-E RY COURT
7301 ! C OUMRY CLUB DR, WT? P
LA 4)U UA, CA 92253
PALM DEZ,tr-:f T CA, 92260
QW).346,4032. C'K.W 1044 '
USE OF PERMIT'
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FER"I2 2001
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:C°MAL MOM FUlts DOX NOW
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[RECEIPT DATE _ jf {�`•BY ' yr�.,/cr DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I DATE
I 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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath ,
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
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
COMMENTS:
`
.47cell
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)
AMPAR- 2 MRS N
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- -SK041ER I AMERICAN
RT1P
G0.SUNE BY SDC FT. l36
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WATERBRITE
RAWER ODLAM WHITE
PQ. GOLD QUART FE VENEER , SDC SQ, 1171 O.
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. . \ • STEP FT. y-•
SPA SPECS
BROOM FINISH
36" Ric-. J DESIGNER SIZE 7 RAISED YFS+1R•
v _ e'•h•, j: LITE 100 WATTS
BACK HOE ACCESS . -,-- - - -- 4r -t. • ••r%' -- -- - Y , J RICWIRDIE LEVEL SEATS 22' 24. 2Y : .
29-1' - - ---
. _ .."RRREIDCIC WAIS- 1BENCH % DATE
..DAMWALL STACKED -
. _\ ��CCJI ii 11•T-� DAMWALLTOP QUAR77JTE
I SPILLWAtSZE 'lI WIDE
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cm 14'
Po ok
PALM DESERT. TEMECULA
3' w1I3E SII)EwA1R- - WATFRBRI - N 73-011 COU4TRY 28910 RANGIO
" TO DRNEWAY CLUB ML STE F-4 CALIFORNLA R0.
RESIDENCE : LA1�E>sCAPE AND SCALIE
PALM 92260 DESERT CA. ' TE 206
T2s90 CA.
ARE SHOWN FOR ILLUSTRAMN [7601 346-40329
ONLY AND ARE NOT INCLUDM N
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GOLD QUARTZITE WATERUt•/E
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CANTILEVER
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signature
CAPACITY ___9.190
-
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CAPACrTY 103 {�
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FLTIER 'STA -RITE 300 SQ FT
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FILTER RATE ImGPM -
-
ARS 400
AMPAR- 2 MRS N
- AtTlL� 3
- -SK041ER I AMERICAN
RT1P
G0.SUNE BY SDC FT. l36
. '� `'� _ . R•'•6• - POOL LIGHT 400 W CLACK T 1048 t7
IiECTRICA BY. SDC230 N
IEAVEDIRT • CANRLEVERCAP AUTO CLEANER GREAT WMTE Z
WATERBRITE
RAWER ODLAM WHITE
PQ. GOLD QUART FE VENEER , SDC SQ, 1171 O.
r j
• I . , O
3JY .: t'•!.• ' A - DECK TYPE BROOM fMH CANYON r
t :
. . \ • STEP FT. y-•
SPA SPECS
BROOM FINISH
36" Ric-. J DESIGNER SIZE 7 RAISED YFS+1R•
v _ e'•h•, j: LITE 100 WATTS
BACK HOE ACCESS . -,-- - - -- 4r -t. • ••r%' -- -- - Y , J RICWIRDIE LEVEL SEATS 22' 24. 2Y : .
29-1' - - ---
. _ .."RRREIDCIC WAIS- 1BENCH % DATE
..DAMWALL STACKED -
. _\ ��CCJI ii 11•T-� DAMWALLTOP QUAR77JTE
I SPILLWAtSZE 'lI WIDE
011 OPEN
` 1 VO R1..n• _ REVISED .. %7T
.. ti: -U• ('i9@9: CHRiS MARGISON
.�a 1 BENCH 11..' -9dGmL% 45-11SSUNBERRY CRT r O
?I �
l'r � i I�tQUIYTA l7 W.
DESEItf PRIDE A
r
P2 . -. PrA I _ 11GHI' SW ITCH •r INA r. . �OD
D
. SLIDER - SLnXR - N
cm 14'
Po ok
PALM DESERT. TEMECULA
3' w1I3E SII)EwA1R- - WATFRBRI - N 73-011 COU4TRY 28910 RANGIO
" TO DRNEWAY CLUB ML STE F-4 CALIFORNLA R0.
RESIDENCE : LA1�E>sCAPE AND SCALIE
PALM 92260 DESERT CA. ' TE 206
T2s90 CA.
ARE SHOWN FOR ILLUSTRAMN [7601 346-40329
ONLY AND ARE NOT INCLUDM N
I909K765M�w