0309-347 (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
69064.1 $ HTC A of�:sa c
Date 'g - p 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:
( ) 1, 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).
( ) 1, 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:
Carrier 31�ATµ FUNT.2 No. F$03906 -b7
(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 pr6visions.
Date. ,I l- 5-0 ? Applicant %I�- ' =.cr••• �- -
Warning: Failure to secure Worke�r�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. W1
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, indemni
& hold harmless the City of La Quinta, its officers, agents and employee Q,
2. Any permit issued as a result of this application becomes null and voirn work is not commenced within 180 days from date of issuance of s
permit, or cessation of work for 180 days will subject permit to cancellati
I certify that I have read this application and state that the above informatio
correct. I agree to comply with all City, and State laws relating to the build
construction, and hereby authorize representatives of this City to enter up
the above-mentioned property for inspection purposes.
`Signature. (Owner/Agent) A, M Date Z0 a%4 >3
'j t_
YLh� NG PERMIT PERMIT0�}342DATE
4i
LUATION r LOT TRACT
.s -�•.. S ttlfltAF1 106
JOB SITE t
ADDRESS 79-910 DE SOLA SOS,
APN
- ..
OWNER •
CONTRACTOR/DESIGNER/EN (NEER
TUT HCY1+rM LLC
RJT iNreEMION-1-8, RX1.
PO BOX 1314
14251:',. UN1WRXff DRIVE'
LA QUI TI`A CA 92133
PHORNM AZ 85034
((502)257.1656 GBIA 990
USE OF PERMIT
POOL AND/OR SPA
POCUSPA, 8BQ AI ARMS/13.ARRIESlt SHAL1. He IN PRIOR TO
PMPLAS TREK ?:1` VECTIO)1
POOLAND74.'►R SPA 1,119
KS1M1JA7XD C:OISIT OF C0X.Tf. 11C'1'3ilN
151000M)
PERMIT r, ER Sd774EMARY
PLAN CHECK FF11. 101.00.0-439.318 fi10.5,%0
CONd'i'1"UCTIO14YFE 101-0,D04,18-000 $162.00
MECHKI41C,'AL ME— POOL 101-000-421-000 $24.00
ELECTRICAL PKE -. P043L 101-000-420-000- $45.00
PLki.lt+lDR40 FEE, POOL 101.000.419-000 $27,00
-TOTAL CONUrRUCs'1'1'ON AND PLM SIF --A=
3�S3.3G
IMS FRE -PAID FEE0
$0,00
TOTALI"ERtt� L' 13'1�S ??C)1:1�6'J�1'
OCT 0 2 1003
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPTDAT/
^
%L' ,� r i
BY /'� /
!" a
DATE FINALED �j
2,r3 — J
INSPECTO
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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final 77
Waste Lines
Heater Final
Water Piping
Plumbing Final
<Tiumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation -
Gas Piping
Gas Test
Appliances
Final 7-3
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.
F
Final
Utility°Notice (Perm)
COMMENTS: