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0201-016 (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 619512S C-53 11111c, (11-8 1043 Ito do r t 4�ri Date �" ''1 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. ( ..�:,—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: Carrieri, 40It�P1"1�Aif Policy No. p4�aDLa14Sl (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 sh4forthwith comply with those provisions. 101 Date: + Applicant 0!Nry Warning: Failure to secure Workers' Compensation coverage is unlawful and 'shall subject an employer to criminal, penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on *his application. • ' 1. Each person upon whose behalf this application -is made & each person at whose request and for whose benefit work is performed under.or pursuant. to any permit issued as a result of this applicaton agrees to, & shall, indemnify &' hold harmless the City of La Quinta, its ,officers, agents and employees. 2. Any permit issued as a result of this *application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 dayswill subject permit to cancellation. 1 -certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for 'Inspe ;tion Purposes. Signature .(Owner/Agent) - A/ A,= � '? Date BUILDING PERMIT PERMIT# DATE VALUATION _ - _ _.._ _ .. _ LOT 01201-016 TRACT JOB SITE p.rty,�r,��yrAY;� I APN ADDRESS ��}—'drEt(?, g . a `.b 1A .s ,�•4.di�'4A67LIA.1 d » IOWNER / ! ICONTRACTOR / DESIGNER / 0 URY Ckti1W1,U, iIJ nt 1l�iSi9i�1wI111Iv i.2i`L31!'0IMA POOLS & SPAS CMP MAN 1635 so. V 51PREMM 771 0200 ,1715 M.141 DMV1, W3.M #A M1�3I:kERN71.1?-?13 O CA 92408 PALM :I:7MIMAIT 0111. 92260 (760)340-9000 CUS, 00355 I USE OF PERMIT 1-11.0 0y, ARDIGIR SPA , -A, �1ARE 3IT (OMP . MF. 4% �'..WQ. ,A2.�.{�t�1l OSA'RRIF tS SHALL BE 1W RL AitE Xf :I RIP,�P .IASTER INSPEr«`5,` ON. SPS RACLOS€ RE 'NOT 'rMI CL$lI, ID +fAl i1MI0SI 121509100 14. Maw TME NUMMARY FLAN 0HEC:K; YES 101.000439418 I;no CON Tlii:1CT10i~7FfiM 101-000-41.94*0 V44100 115RCHANIO,A.L I�1�e. ,•. POOL 101,1000-421-000 $24.00 8419Ct'.F.I0AL PM, I. 7>0ot, 101-1000-420 400 $1.5.00 P'L1TMM E1y1. -- POOL 1.01 >'OOO-419,000 WIN ii .J RECEIPT I DATE I BY ' I A= PLAINT 0,MCK, FnH,D%11 NOW 33 i 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 Wail Firewall Exterior Lath Drywall - Int. Lath Final Final. BLOCKWALL APPROVALS Set Backs Footings Steel Electric Bond Main Drain POOLS - SPAS 1 Bond Beam Approval to Cover _ Equipment Location Underground Electric Underground Pibg. 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 Sewei Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas'fest Appliances Final Y,15 , 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: i