0201-097 (RPL)LICENSED CONT"CTOR DECLARATION
I hereby affirm under penalty of p#;j'ury tJ� t I am licensed under provisions of
Chapter 9 (commencing with Section 70 0of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
6561 2$ 'C;3 Inlic CW
Al
Date • ' r Signature of Contractor _.
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, 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.
*�,. ( ), l,.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 9policy no. are:
Carver Policy No.
TATE t:;C31�I MA,TI 044-02 0,006168
(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 orthwith comply with th se provisions.., 'j, IL
Date:- 4�r�r_ Applicant�� .~•�f� rs'+�.R.vx";.'
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 Sec�ic 3706
of the Labor Code, interest and attorney's fees. @J
IMPORTANT Application is hereby made to the Director of Building .a d afeyAN
for a permit subject to the conditions and restrictions set fo n his
application.9
1. Each person upon whose behalf this application is made & eacl person�e
whose request and for whose benefit work is performed under or... ' _..__t Fffl
any permit issued as a result of this applicaton agrees to, & shap, 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 voidif
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 a� horize representatives of this City to enter upon
the above-mentioned property,for inspection purpose n
Signature (Owner/Agent%Hi Date ✓%��+�°"
BUILDING PERMIT PERMIT Ji
DATE VALUATION LOT Odis1 ' I TRACT
ro� •7s�rJ..Aiys
JOB SITE
APN
ADDRESS W-112 VIA CARMIUM
OWNER
CONTRACTOR / DESIGNER / EN (NEER
".C.1'3. DESERT Zt]"'V; WATRNT
C;AT.:l i lt-WfA..P00LIS & SPAS (1-011 MAN C01
P10. BOX, 1716
74'x' 25 J01 -U I:R1,VE, N LTE 4A.
i.A.�11i�3 i'A. (°A 427.53
PAUNI.1 WDM' C;A. _02260
(Mt)340-9000 ang ow45 s
USE OF PERMIT
P001,OTv��O
JPAV .ilyy((0BO ANSI 7,59-J7fKA .l}aATURE. AW.aR 13Y99 11 .
WALL BE fN MAC* M -PLASTER MSPWTION. !)1...F. 0, F. 5'
H101. BLOCK WALL MCLOSUPSK CITY S'.I'.6A.XI)MR0.
POOLANIDR SPA. 17,500.0- L3
5.0Y. WALL 5.00 1.11
lli SI7A.�r
PLAN O rXX FEE ' 101.000.439-.41S
CONSMUC: ION PRE 10-000-118-000 $189.00
MECH"ICAL FEE — pp, 01, 101-000-421-000 $24,00
F1rhC'1'RICtAL P7,E „ ;PCIOL )01-000-420-000 $45.00
_
PLMB FRE. -- P001, 101-00641V-000 S .pfl
�µ
1200,
A
t 2?.`'3A3` M -FAM EEO
T rI)T 1L" MOO r S DACE NOW
SWIM
RECEIPT
DATE
� / -C
BY
DATE FINALED
INL2ECTOR
c J I"
-
f ,/ .'N
s
.,
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
i arty Wall Insulation
Condensate Lines
darty Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
J
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
a
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 Voftage Wiring
Fixtures
-
Main Service
+SY
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)