0403-259 (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
4.55121 B C29+l 1'1J,30/0
Date Signature of Contractor --Z,
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that llamm xempt 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&RC. 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.
(A,) 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:
Carder PTAT'E. �AllID - Polley No. 1612768.03
(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 1provisions of Section 3700 of the Labor
Code, kshall.forthwith comply with those provisions. ,}}
-Date:, ' � ' `'5 `t . O ` Applicafn, t...--„_s%F r�"�+t,...1��
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 compensationAamages 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 property fohnspection purposes.
Date c.a
Signature (OwnedAgent),
'BUILDING PERMIT PERMIT#
DATE � VALUATION LOT TRACT
'
JOB SITE
ADDRESS 7&334 CA:.11.:L1�' IA.T Rt '4'31.�s,� .,r
APN Y w
' OWNER
CONTRACTOR / DESIGNER / EN (NEER
PHYUL]S FORD
'I't713MAN RUMDE
78-334 CALL ,1_«t`AS ".AIV1DL.!A-
PC) BOX 10202
a.,:tl.-lilT m CA 92253
PALMZ91~SERT CA 92.255
(?60)172-7296 CBI.# 625'
USE OF PERMIT
POOTIMID/Oft SPA
IV'C3OL v� wilA ONLY". ALcSl'hISISARRIIERS SYI.Af..{, HE IN P1,A.CZ PRi0&* 'A'O
P001, ARMOR SPA 24,000.00 1
EgrJAWM CobIT ar, Ct)119.11RUC:!"1}on
2410 000)
FLAN MEM PE2 101-M-439-318 $157:95
vfMSTT1UCTI0N' P'L09 101-W- 10-418-000 $243.00
MECHANICAL FRF 101.000-421.000
MECHANICAL. PSE — POOL. 101-000-4.21-000 $24.00
E):.EC'f T ICAL FRE -- FOOL 101.000.420.000 '$48.00
MUM= PP;s — Pool. $27.00
AT+Y�
f~C . ,aCTC't�ON A3�C?:�%._A�4'C'HF=-
$496.95
LMS PRE -'AM '^
ID
$0,00
MA 2 5 2004 T` ..PM&M" 1 YxS 3DUxX0W
4
VM9
CITY OF LA QUINTA
FINANCE DEPT. /
RECEIPT
DATE,
BY
D9jFl
GfvS
INSPECT
F�
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel — A/
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
—
Underground Electric pzy
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final —1151— <
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
Final
Utility Notice (Perm)
RAISED BOND BEAM AT +18"
WITH CONCRETE GAP AND STONE
VENEER FACE
PROPERTY LINE
�-E,49ET�ITLINE----
I P9.
PD. +18 RA15ED SPA AT +18" WIT
GAP, 5TACKED STONE 51
/ AND HANDRAIL
POOL
WITH PEBBLE FIN15H
AD,
NE I GHBc
,• ' I� ENTRY
BENCH
STEP5
'
ALLS, TO REMAIN
`�' •• r.. �,.�.., ti• IHR• • ••1
SALT FINISH COLORED GC
PD. �: ` :� , ,y ` , . ' •. ' DEGKIN6, COLOR TO BE
Vii;. ', ..:''. � •.ti• ..; ,, ... .`'
. I t? ..: ; •, `:; '� y�.. ,:,:.:.. .. �.. ':•. ' �•. • �,::', . � �` `' �.;, . I EXI5TIN6 WALLS, TO REM
PMENT AREA, MOVE ' ❑ ADD DOOR ALARMS AS
,L A5 NECESSARY ' ❑ NECESSARY
RE—INSPECTION FEE OF $3
PHYLLIS FO$W 10 " ca MILL BE CHARGED IF THE APPROVE
�978-554 GALLE LAS RAMBLA5 �LANS AND JOB CARD ARE NOT 0
�%iil( OF LA ItTA DUNA LA OUINTA LA QUINTA IIHE SITE FOR A SCHEDULE
BUILDING & SAFEE DPT. �,4� INSPECTION.
APPROVEC I NO EXCEPTIONS!
FO CONSTRU 10 3s
DATE