0009-200 (RPL)LICENSED CONTRACTOR DECLARATION -
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chaoter 9 (commencing with Section 7000) of Division 3 of the Business and
-r'Issionals Code, and my License is in full force and effect.
License # Lic. Class Exp.�Date
.,k
634981
Date,` ^Signature of Contractor
OWNER-BUILDERDECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
(.) 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:
CarverSTATE FUND 1542,07-00
No. 1543.93'9.00
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the perforrrm ce of the work for which this permit is issued,
I shall not employ any person in a y manner so as to become subject to the
workers' compensation laws of California, and agree that ifJ should become
subject to the workers' compensation provisions of Section'3700 of the Labor
Code,.l'shall forthwith comply with those'provisions.
Date`. 1 .4 Applicant
Warning: 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] 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 representativesiof this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) , "" r� Date `C
BUILDING PERMIT PERMIT Ji
DA:..LVALUATION LOT 00�. -.l�W TRACT
� Scd:tiUt3.4T(D -
JOB SITIt APN
ADDRESS 4-7_4AVEMA VAMAU0
OWNER CONTRACTOR/DESIGNER/EN (NEER
COR.ONM CONOiRMMON COMM, CON 3S�itTl'MON i
78r1.50 CALLE 1"A?. ICO 9Uff 230 78-150 C1�1LLETIA�i+IMO SMEE0230
1A tWfA CA 92.253 LA QiJYR1 T'.A CA 9.2253
(760)56414604 CBIJ. 2261
USE OF PERMIT
POOL ANDI R BUPA
POOL. ONLY-.ALARMSISA,RRIERS SHALL HE IN PLACE AT PRE PLASTER
TwSPFeTION. Pom W1PMKK T ENCLOSURE 18 NOT INCLtJM M THIS t
PERMIT
POOL ANNOR SPA 81000,00 LS
EM"M COST OF C(3N6'TICtUt"ICON �,OiIO 0ti
PE:E2AM FER 9UMMARY
PLAN CHECK FEES '101.400.439.318 144.35
CONSTRUCTION ISE 101-0001,418-000 $94.00
EL MUCEAL FEE P06L t 01-00014201 000 l5,
PL11.mLNa feE -- loom 9 ;101 000-419-000 0".00
SEP 2 8 20M
LA • k .
COI+iStRUC'i'.ICH AND Pa' A14 CBECEC
IMS PRE -PAID FEES
TOTAL P1E171M FRES D'(TEE NOW 5235,35
1 ;
RECEIPT DATE. Bl" - `e DATE FINALED INSPECTOR ;
INSPECTION RECORD
G 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
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
,p
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)
COMMENTS:
- • - a- -+ _ +K• _. - - PCMRRp .. - - y - - �� s sects IAaa ' ^ ' - �+ •' -
LLE �
77) A RE-INSPECTION rEE OF 4 ice 54-755 AVB,Vr�a.LorVO. WILL BE CHARGED IF THE APPROVED"'-
LA QUI TA, CA 92253'
PLANS AND JOB CARD ARE NOT 04
THE. SITE, FOR A S00" `
' '-f�' .l�--, _ �•.'�ar.•� � �• T�.•.._ f CONST.
CORONEL V T.
\
z_ - SD. BOX
_- - —==J ' �E' HaL' �E Imo— -- �-
•. .r `I- `' i P389
OF(AQ INTA LA QM-MTA. CA 922S.3
— � r t� . • . -
"Zi'LDING& SAFETY DEPT. s
• • 4` � ' � I .. T v I � �` � � O lS D e � • .. -- _ UEF'- 564-4604
68 CCY RAL - 1
- - } - - FOR CONSTRU TION PAGER. 362-354
HOUSE REVERSED FLAN , pr
AML 17'x12' W/ 1H.p(^Tp4P '
DATE71
BY
a
SPA Ri/HEATE.R
=5c/
G�..a _ - - ' �•'-� - r scALE: I I8 ♦PPPOwm 6Y' CNA'A'M BY P l 't
- • • ]A-E: GEYI9E0