9803-061 (RPL)"z. LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
pter9 (cogimencing with Section 7000) of Division 3 of the Business and
rofessionals•Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
C53 C27J�~''' 6/30/98
Date .` - /5y Signature of Contractor .- --�
F� 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.
(�)" 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.
(This section eed of becompleted if the permit valuation isf6r 00.0�0 or less).
( )'.1 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, d- al o hwith comply vyitErthos -,prowl Ions`
Date: ApplicantV�-~-'"'"-'
I X1
Warning: Failure to secure Workers' Com,1pennsation coverage is unlawful and
shall subject an employer to criminal penaltie's 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 representatives -of this City to enter upon
the above-mentioned property4or.'i pection pug)o i s.
Signature (Owner/Agent]�r! Date
y
t
PERMIT# CONTR�OyL#
BUILDING PERMIT
q
DATE . VALUATION LOT 9803-()61 TRACT �a 31
6J 1
Ha 76
s.13.00.00
JOB SITE
ADDRESS
APN
79-1.10 KRISTM C(DI:TRT
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CENTURY CROWELL. CO[a1MUN1TI.ES
BATE PALM ENTERPRISES
1.535 SO. "D" STREET, STE. #200
74-8181VE LIP, WAY 4-05
SAN ETRNARDWO CA 92408
PALM DESERT CA. 92260
(760)_A46-2504 CBI,# 1888
USE OF PERMIT
4.
POOLISPA ONLY. ALARM/BARRIERS ARE TO BE OP&kVIONAL PRIOR
TO
EAI-CAPIPRF,PLA,STE,R .[NSPHCT[CN
AID
APR
0 3 1998
FOOL AND/OR SPA I3,fwo.001.3
C1Ty O
Lk OU1NTA
ESTIMATED COST OF CONS'T'RUCTION
13,000 -60
PERMIT FEE S'4JI.01AR1'
PLAN CHECK FEF 1.01-000439-318 $93.60
CONVRUCTION:I:.EE 101-000-41€S-OGno 3144.00
.
MECiHAMICAL M— , — POOL 101-000-421-000 $24.00
fuL.EUr..RIC AL FM FOOL 101-000420-000 45,00
PLUMBING 1166 _ POOI. 101-000-419=000 $27.00
SUIC TOTAL C';ONSTRUCI'ION AND PLAN CHECK
$333.60
LESS PRIG-VAID F 8E8
$0.00
TOTiU, PER1111T FEES .DUE NOW
$333.60
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
S'et Backs
Underground Ducts
FJrms & 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 - 17
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test Irv—
Final
PLUMBING APPROVALS
Gas Piping
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
f
or
Final
Utility Notice (Perm)