9703-091 (RPL)N U)
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LICENSED CONTRACTOR DECLARATION
'A 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 I _E-xp'l7ate
/Date ignature of Contractor I
OWNER -BUILDER DECL RATION
I hereby affirm under penalty of perjury that I amYexempt 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.
.u\
'V1 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 Policy No.
(This section need not be completed if the permit valu tion is for. $100,00 or less).
( ) I certify that in the performance of the wo or which this permit is issued,
I shall not employ any person in rfer so as to become subject to the
workers' compensation laws of Cali nia; and agree that if I should become
subject to the workers' compen Ion provisions of Section 3700 of the Labor
Code,,[ �
hall f$rt lith comply WithtXho g p!gyislns.
. f
Date:
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 c�jpcellation.
I certify that I have read this application and statethat the ab ve information.is
correct. I agree to comply with all City, and State law ating to the building
construction, and hereby authorize re resentativ -of his City to enter upon
the above-mentioned property for ingpgcy?n�yrpo�es . GIT
gnature (Owner/Agent)
Date
BUILDING PERMIT PERMIT#
990-"=
CONTROL//
4853
DATE 3%25/97 VALUATION
516,70.00 LOT TRACT
JOB SITE
ADDRESS 79-.345 DUS URT CREST
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JI.:) i<: Ct�I,l�tiFh
CA&ffl.,Y POOL; CON S'i'RY CTION
79-3415 DESERT CKEN"T'
_53300 Aif1~N11:1A ICAA'ilttr.L
1.t1QUIMA
CA 92253
1.A QU1NT4 CA
92253
(61.9)564-3555 C1
i N 21393
USE OF PERMIT
(BOOL.
POOL ,BAWD 3MONLY
Vf i:uM'.itilJ
ifi,'Iw.00.i.,
i%` I �isia`T 3 CONT s�'9. F C0111NiITRUCT110N
16,700.00,
VIEW' SUMMARY
PLAN i,'.k1ECK, FTT-
MI -000.439-318 SH7,00
(110NST12UC"1IONFEIF
101 -OW -418.000 5180400
X93CT•1.AMCAL FEE ••-.i't:7e., L
101-000-421-0110
i .tai vritl:C:A1 dauT3 w 4ytU0......101,400,-420-000
$0.00
Pi.T,1NUMNO FHE - POOL
101:-00!)-419- 01M $2.7,00
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LES,"'.Lt y c`S-193.00.00y9±t31
TOTA-11, l''k"RE.S DUE NOW
.
$39.3.041
MAR 25 1997
ii E' T
DATE
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Root Deck
Exhaust Fans.
OX 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
Set Backs .
Electric Bond
Footings
Main Drain
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
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
Uti14 Notice (Perm)