0404-018 (RPL)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 Exp. Date
%561 u 15:3 sir' C-8 10:31101
Date Signature of ContractorIF
!9
OWNER -BUILDER DECLAR' T,IO
C Rzot6A11%1_,e
I hereby affirm under penalty of perjury that I am,exempt from the on r6cto�es
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- ipjissued�,,.CM�yhwp eKX9D npensation insurance car g�1t3p$Jivyf no. are:
Camer Policy No.
(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 shall forthwith comply with those provisions.
Date: Applicant
WarningIza IUre o' secure Workers' Cf. on pends tion c9rer ge eu,lawful and
shall subject an employer to criminale�?aides>and ely lfi es r(p'o $100,000, in
addition to-the.cost of compensation, damages as-pr�d d fog 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.
mployees.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) Date
BUILDING PERMIT PERMIT#
f 0404-0�1.4
�2ATE --' VALUATION V.8,2SM LOT 1021 TRACT,
j
JOB SITE 81-8.57 SUNT CACMJS LAMP APN
ADDRESS
OWNER CONTRACTOR / DESIGNER / EN (NEER
* ARO S CALSI O POOLS & SPIES CrOP 14iAta
.C".O:
81.260 AMM ULi 62, 86- 1.00 AVENUE; 54
LAQ[J'INTA. Ci3 2883 COACRELLA, CA 92236
(760)398.9222 CISLIO 001355
USE? FC3l.%R.tM,ist+i�i/CiLt. n`IP Aa
ALA.R.MMA,1t1LaERS SI;i.AI.L !3L W PLACE PRIOR, TO PREPLAI`TER
fId aPECTION.
P001, MUM SPA
5 !Vr. WALL
legato is
13,00 LP
EMMAJC`fr&13 {TOSYL' OF Ci?NS'.iiRYTCMOR
1817-591W
PLAN CHECK FEE
101"000-�3�•31€i
�16v.'Ytf
CONS3i RUL'"1'ICYN FEE
101-000-419.000
$19$.00
MECHANICAL FEE --POOL
10'1.000.421.-000
$24,00
I?LFC` PJCAL i'irZ -• POOL
101.000.420-t000
$45.00
PLfJmFi+1t1FEE -- POOL
101.000.419-000
$27,00
TI' -TOTAL 0014S`i32U;C1110N AND P.LfilT f fC $42110
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REGEIPT "''DATE;iBYt y✓ 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.
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
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 Z
Sewer Connection
Encapsulation Av
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)