0006-106 (RPL)LICENSED CONTRACTOR DECLARATION -„
I hereby affirm under penalty of perjury that I am licensed under provisions of
Imo- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CV W Profes�sRIMMs°Code, and my License is in full force and effect.
E; n M License # Lic. Class Exp. Date
LU 4 On
r- 476807
o Z DafT-"�� Signature of Contractor
0 '
I- CD co OWNER -BUILDER DECLARATION
UJ LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
-J
~ co License Law forthe following reason:
Z_ ( ) 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).
C'`) O I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
,0 C\
rn
',a Q WORKER'S COMPENSATION. DECLARATION
o, cc I hereby affirm under penalty of perjury one of the following declarations:
Lo,
.H O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X'' W LL compensation; as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work; for which this permit issued.
Q I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d LO Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Canier
co .� ;STATE FUND Policy No. 229-- ITIO ' 00204$4
�v
g (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,p ovisions of ection 3700 of the Labor
Code, I - all forthwith comply with the visions
Date: 2— ppiicant
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 1he 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 benefitwork 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 foQns'-ectionjpurposes:
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
I�_106
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 45_o4o DrillirE
OWNER
CONTRACTOR / DESIGNER / EN &NEER
WEVER FWV4'
AQUAQl:]1 ST POOLS .
45.040 NW&
80-9751N.010 13.1;VD,
LA QUhNTA CA 92253
PALM DESERT CA 92255
(760)345•,5070 CL11A 130
USE OF PERMIT
1:1001 AN D/CiR SPA
POOL & SPA ONLY - ALARIASWARRIERi SHALL Blt; IN PL.AC E-tiT
PR ,PLA4`1`ER. FOSPECTION. DL()VK WALL FOR RQUIPM[r)NIT eNC;iXrAJR.C5
IS 140T INCLUDED IN THIS PERMIT
POOLA"NDIOR SPA. 14,000,1110 L3 r
F A'1.*UD 0011 ' OF C 0..NS-MU(:T10N
x.4,c>4JakICs
PKEM ['I' FEF l,+ UM-MARV
PLAN CHECK F Ui, 101-000-4 39-318 WAS
CONSTRUCTION PSE 1011-000-419-000
MECHAVICAL FFE -- FOOL 101-000-421.000 824,00
NLEC:TRICA1, FPS •- 11001, 101-000-420-000 $45.00
K-UmBrNO FEE -- POOL '1014000;419-0011
w.
8'UB-13 AL CCg)ib:tWICTION AM) Pl._W01 IE(.,K
$346.45
LEE -Plus }'AIL" IT .S
$0.00
TCa'I'.A_L FMM ISS DMNOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Of SPECTM RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
®LQ MNG APPROVALS
MECHANICAL APPROVALS
Se Back's
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 I
POOLS _ SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Main Drain
Footings
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground P1bg. Test
Final
Gas Piping
Na AfTROX-
PLUMBW(S 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
I m) IlIZ Z, Ce
COMMENTS:
ca
16
-
Final
Utility Notice (Gas)
ELECT=AL 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)