9611-085 (RPL)LICENSED CONTRACTOR-DItCLARATION
I hereby affirm under pen . alty of perjury :'that I arn licensed under provisions of
Chapjer 9 (commencing with S ection 7.000) of Division 3 of the Business and
Professionals Code,�:and-rry License is'in full force and effect%..,
OWNER -BUILDER DECLARATION,
I hereby affirm under penalty of perjury that I am exempt from the Contractor!s
License Law for the following reas�on:
1, 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).'
1, as owner of the property, am exclusively Contracting with licensed
contractors to construct the project (Sec. 704.4, Business &-Professionals
I am exempt under Section B&P.C. for this reason
'
WORKER'S COMPENSATION
^ DECLAR/TlO| -
| hereby amnn under penalty of perjury one of the following declarations:
( ) | have and will maintain a certificate of consent mself-insure forworkers'
vomponoauon, as pmvidodfo,.by Section 3700 of the Labor Coda, for the
performance o/the work for which this permit iaissued. �
( ) | have and will maintain workers' compensation --insurance,oorequired by
Section 3700. of the Labor Code: for the performance of the work for °miox this
permit is issued. My workers' compensation insurance, carrier policy no. mn�
Carrier Policy No.
�;rAIt. FUND ~ � �
(This section nee . d not be completed if the permit valuation is for $1 . 00.00 or.16.ss).
I certify that in the performance of t 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 Califd"rha� Ahd/agrWe4dif I should become
subject to the workers' compensatiorl provisionsibf SLiction 3700 of the Labor
Code, I-shal forth- ith comply wit those^provisions.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil f ines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3766
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 hi's
application. .
1Each whose behalf this application mmade ueach 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 applicdtioln and state that/the above information is
corre6t. I agree to comply with all"C,iiy, and Stateda�s relating to the building
construction, and hereby autho rizel representatives of this City. to. enter upon
the ab6Ve-mentioned property for inspection purposes.
DATE) VALUATION LOT., TRACT
OWNER
CONTRACTOR DESIGNER ENGINEER
LA QUINTA CA. 922,51.
PALWORSERT CA, 92260
USE OF PERMIT
4100LANUOR SPA
11601, AND SPADNLY
PGOL AN1,W401t SPA. 12 `000,00 I's
PERMIT
PLAN CHECK FFIR M-0004-39-318
= ZZ,
.NWIAMCAL FES —YOOL 10t-900421-000 $24-00
"M Pool, "101-000-419-000
Cn
LESS PRE-PATMES
OW
RECEIPT
DATE
BY
DATE F INALED
INSPECTOR
INSPECTION RECORD
I—
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footing's
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Iht. 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 PI : Test
C�
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)