9810-123 (RPL)}; LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H;. Chapter 9 (commencing with Section 7010�O) of Division 3 of the Business and
94 W Professa,.;als Code, and my License is in full force d effect.
� `'Dense # Lic. Cl s Exp. Date
o0 LO 425381 E3 �, i � .78vob
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[70 �ci
oZ ate Signature of Contractor
J U C:) OWNER -BUILDER DECLARATION
W W rl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a License Law for the 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).
co () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
p N
d z WORKER'S COMPENSATION DECLARATION
C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Ln
0 () 1 have and will maintain a certificate of consent to self insure for workers'
X W �: compensation, as provided for by Section 3700 of the Labor Code, for the
0
c0 � Q performance of the work for which this permit is issued.
Q V �) I have and will maintain workers' compensation insurance, as required by
QU Q --Section 3700 of the Labor Code, for the performance of the work for which this
d L Z permit is issued. My workers' compensation insurance carrier & policy no. are:
CarrierPolicy No.
co S;'.tR'1a? FUtJD f.2Et1+?�'Q
�CY
Q (This section need not be completed if the permit valuation is for $100.00 or less).
—J ( ) I certify that in the performance of the work for which this permitis'issued,
I shall not employ any person in\any manner so as to become subject to the
workers' compensation laws of Ca�ifornia, and agree that if I should°become
f' subject to the vd rkers` compensatio provis"ons dySection 3700 of the Labor
v Code, �.:& tZIJ hw�th/comply wit th , s 1pro sio' s�'j�
Date: Applicant
Warning: Failure to secure Workers' CompAea
ation coverage is unlawful and
shall subject an employer to criminal penaltind civil fines up to $100,000, in
addition to the cost of compensation, damags s 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 here authorize�representativeski ,of this Gity toLent;upon
he above-mentioned pro lerty fR inspection purposes.
Signature (Owner/Agent) ' Date
BUILDING PERMIT PERM'CONTROLN
DATE VALUATION ;�a,�t�.a LOT TRACT
8479
VV479
JOB SITE
ADDRESS 54035 AVFNIDA MAZ
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
F.A,CHICTRADES CONS°LFt:ITL'"t.'lON
PAI.CIFIC`i`lZ.tWESCONSTRUC'HON
.1719 S TREMONT
1719 19 S TREINI ANT
S OCEANSIDE C.A. 9'205!
S OCEANSMY CA 92054
(760)99.-,7-0069 C ).# 1955
USE OF PERMIT
POO 1, AN DIOR SPA
pool oldy A1011eateI
PWL ANDVOR SPA ;13
1I1r&::I't91XrE1D CM OF c®NSTR C"I"ga "d
I`ER1`►M FEE SUMN11:0(
PLAN MUCK FEY ' 101-000-439-318
('YNS rRkJ(', fXO N F E, ) f) t 4'"-111 P -0M_ $`3 i..!?t►
ELECTRICAL 1=. -POOL. [H-000-420-000
PU1M I NG jTX3 -- POOL �lW 1 -IDOL -4 i 9.000
G 1r 't I t
OCT 2 ® 1998
OF Lir QUId IA
, [)ti_`►Y , t, C'Cf I lriJ 'Ir�P1 AiV!) P
LESS PRE -1 A,ID i EES
41,00
`iO'.0 AL :f'1r.:RN 'I' 14,04 DU 1H NOW
,S2s15: 5
RECEIPT
DTE
U� ��
BY
DATE FINALED
INSPECTOR
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
Pa(ty Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
POOLS - SPAS
Q
�� 7
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
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
c
Final
Utility Notice (Perm)
COMMENTS:
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SUBJ7':CT TO INS"'At LA TRION AS PER
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AND ALL APPLICABLE CODES
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