0010-158 (RPL)U)
H
C14
W
O =) M
Q
W
6zr-
CD 0.0
_J cD
F-
LLI
t- a
Z
M
LO
N
ON
U °)
CLQ
Lo a 0
X" W L_
mU(a)
O
d rnH
Iq Z_
ob ry
0
J
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
Date 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 �1` I, as owner of the property, am exclusively contracting'with licensed
contractors to construct .the, project (Seca 7044, Business & Professionals
Code)` 1,
O f am exempt under SectionB P.Cf for this -r'
4eas6n
ate t ?, a Signature of Owne �„ ^°r
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. Mei workers' compensation insurance carrier & policy no. are:
Carver Policy No.
(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.
Date: 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.
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 ab mentioned property for inspection, purposes:
Signature (Owner/Agent—),:",,— r a Dater_
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
JOB SITE
APN
ADDRESS
79-6140D AI'1DMON DMW
OWNER
CONTRACTOR/DESIGNER/EN (NEER
�1.I6
�6i
�,M
�CV�
VA�aA: :d�O;LY3�CLE sEn73
atp3y
ALE,
PALMDFOR3,T CA 92211
PALM DOW CA 92211
(760)347-3401 MLIq
USE OF PERMIT
POC)LANEYORWA
PGOIASP.Fs "A.I...ARM/BAr &ElabXRX' 114UST 89 IN PIJ,IM 9.AT PP—TI-PLASTER
111HR(aC:` iON, i'30', 'Kaf 1Tr CLtUn}; POOL �A 111105URE
MUi ANIVOR. SPA 211000/00 W
a��y4.NJVJX X_D CW CXF •�.r9�.6!'l�afi�X�L1MIO.ltl
2:51VHCJM
Q �+� $' �v •�^�Vg;*�y� yty���t, g��
,1��.34�%-��.�5 .R4Ir4al]� S7J1�•1LC.}29:p.
PLAN (IfFfM FZEn 101.000.4.9-3 18 $163M
CONSTRUCITION F'ZE 101-10C10-418-000 S233.0
MECFf INNICAL Ift -- POOL 101,,000-421-000 $24,09
9=119.11C t9ER -• P°:OL, 101-000.4,20-000 945.00
1'lrtiMBING F&F, ..POOL 101.000.419.000 $A00
`dw
.
" SM•=M L C ONT. at'RLiMIOlwi Ake ]PLAN (° -MCM
$511.80
L1IM13 PU. ' -PAID FON
S0100
TOTAL ��'�.RWIT:�:tt.X16 VUE NNWx.80
OCT 31 2000
ue LA
-'#*IT-Y
R CEIPT
DATE
By)
DATE FINALEDSPECTOR
2.,l .. -r)
} .a
•- ti .- srl
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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
r
Underground Electric
Underground Plbg. Test
1_ '_
Final
PLUMBING APPROVALS
Gas Piping
Gas Test
Electric Final
((` ce,
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
y�
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: