0202-190 (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
f f 614611 C5� •-- •' ()IM �, x
Date' ' Signature of Contractor+ l W°' `�-"
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 declaratlons:
( ) 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.
,,5k) 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.
�1;�'a�'� Ir�klta Gr143Q�+1&�1;i.
(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.
DateQ"�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. I-
°{
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 underor 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 property for inspection purposes.
Signature (Own(. _ �'- -a + •• Date
er/Agen
BUILDING PERMIT fERMTN
DATE / VALUATION LOT L/�wN� TRACT
JOB SITE
APN
ADDRESS • � 950 LA. Ili MA
OWNER
CONTRACTOR / DESIGNER / EN (NEER
x.5950 L&RENA
P1011 BOX 1791
LA gJINTA, CA 92M
1A Q 3`WA CA 92253
t s0 585 Midi 1945
USE OF PERMIT
POOL AND SPA ONLY' AL 3bMSIRA IVRIS SHtil,,1., 'ISE, IN PJ111KCZ PRIOR
TO PKfgP,l:fASTF.11IM1 eafiON. p0m. F)QSUIFrjVir R-Ne.ws0mv.N07
MCLUDMOM PERMIT,
Pool, A141XOR SPA 1.5,000.00 Ls
xzmm'k`v cS7grol? i:CD.Y!:lal<;km+G'I aim
RAG ¢.1:r' 114MAWARIv
C'N CIQIICK FES. 101F-000.439-318 SMX
C0143, rRUCTION FEE 7,014=418.00;
HMMNICALFC,Z - POOL 1531.000-4.21-000
fi: P rt ►. , .e , �G,Oi, 101-0 -42 -00Ek 5.c
PLiiA1IX3YNO . ? , -• # 06L 101=,aWool
r,
FEB 2 2 2002
CrNVF kl'C'KUIR-m '
336.3,10
•:b?AEt1F-P. M,
$0.(30
'X' rAL V Imm> `T.11f3IMEnow
RECEIPT
DATE rI
%z
BY ;'�M
DATE FINALED
INSPECTOR
,
r
►k
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
BLOCKWALL APPROVALS
steel
POOLS - SPAS
— ?a- z
Set Backs
Electric Bond
t Z
Footings
Main Drain
Bond Beam
Approval to Cover ,qe—
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
• Z, G - Z
Gas Piping
Gas Test
Appliances
Final
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:
+1211 BENCH
POOL
DOLPHIN BLUE PE LE
Vl' PINISH KTH BLACK SPECS
ol
=D CONCRETE-
sE
BENCH ENTRY
.. STEP5
NT WITH
LTRATION
C.
PE
LA :S;- q S-0 L iA 2 E 0 NA S "f'
CITY OF to QUANTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUG71ON
EXI
DA Z L,0 a
TINCT
LENGE
RAISED SPA t
CONCRETE GA
TILED SPILLK