0004-318 (RPL)tr - LICENSED CONTRACTOR DECLARATION
I he,'eby khf under penalty of perjury that I am licensed under provisions of
: Chapter,9.ycommencing with Section 7000) of Division 3 of the Business and.
Professionals Code, and my License is in full force and effect.
License # Lic. Classy Exp. Date
�3. 1 E> E'S3� 1 12i
Date 4)Signature of.Contracto.r
r ,
OWNER-BUILDER(DECLARATION
r
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. .
('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 STATE FMID Policy No. a29-00-60IA3
(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-Cafifomia, and agree that if I should become
subject to t e?w6rkers' compensation/provisions o�Section 3700 of e' Labor
Code' I -s ` II f rthwith comply.,with.t provlslons: ,• #
Date:; ! 1, APPlicant
Warning: Failure to, secure WFrkers' Compensation coverage is unlawful and
shall "subject an employer to�crlminal 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.
P
I certify that I have read this application and state that the above information: is
correct. I agree to comply with all Citytand State laws relating to the buoding
construction, and hereby authorize rep+ se dhtatives of this City to ent f u 6n
the above-mentioned property forlinspection,purpo es.
, ' • `�" F
Signature (Owner/Age �)'� Date
BUILDING PERMIT PERMIT#
DATElY s
([ VALUATION LOT -3Y8 " TRACT
rf�i,�3iJ 265
JOB SITE
APN
ADDRESS 47-700VIAMOMA:Nd.A
5434,204*7
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CAR1ADAY & CO)di MY
HAL HA1uh'TON dba VACAnON P0 OLS
1570 TBRO01HrOLLOW DIVE, SUITE 208
9522 DONAL1`3SON Its?,
3AITMANA CA 9,2705
LLIG''1±.'I2 M VALLEY CA. 92356
(909)248.6045 CPJA 4335
USE OF PERMIT
POOL ANWOR SPA
POOL ONLY- S14AU BE IN PLAC O AT .
�yp&p(SP.{A�,r'�tArL�Ak�:lMSXHAi2RIERS
PILE -PL S�yFA lLYS GC!.FON, 1
VALUATION 13,000,fl0 is
R.MW i•7.`M COST OF C011S7• VCJ70tq
93,C1t?0.(>i9
PIAN CIICK M 101-000-439,i,318 $93.60
CO'NS'TRUCTION FEE: 101-000-418-000 $144.00
MECIViNiCALFEE --POOL 101.000-421.000 $.24,00
r -
ELECTRICAL IEEE — POOL • 101-000-420.000 $45.00
PLUMBING FRE - POOL 101-000-419.000 M.00
SU:1$40 AL C01491-,U'C"11014 AND PI AN t L
$333.60
.TMS PRF --PAID FERS
$GAO
TATI FT-11four ME Is DUE NOW
0
RECEIPT
DATE. 'BY (J{�'� },'C'1,
DATEJIINAAL�sp �.�
INSPECTOR
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
Set Backs
Electric Bond
Footings
Bond Beam
Main Drain
Approval to Cover
i7
Equipment Location
Underground Electric
-I I
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
3-O 2 -
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: COMMENTS:
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