0202-191 (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
Date z! �'-_ Signature of Contractor I J 14 11 /Jf1
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, 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.
1 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:
CaPolicy No.
Carrier 3"� ATE C`•Cy1�f�F 3tt,T 04642 D005163
(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:'�'AZ Applicant
Warning: Failure to secure Workers' pe sation coverage is unlawful and
sh II subject an employer to criminal penalt es and civil fines up to $100,000, in
adcl%i to the cost of compensation, damages as provided for in Section 3706
of the Labor, Code, interest and attorney's fe';s.
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. N,
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 above-mentioned property for inspection purposes.
Signature (Owner/Agent) % t - vDate2'2s
BUILDING=RERMIT PERMIT#
DATE VALUATION LOT 0202-191 91 TRACT
JOB SITE
APN
ADDRESS W_89
OWNER
CONTRACTOR/DESIGNER/EN (NEER
G:
M;4+7'OVA.IVIYE R1~.St'%W COW.AJAIT10S, INC.
CAU tPORNIA'Pt)OLS & WAS CM11:1 AN COT
2Q0 L WiSM14MON AVE 1(0
74.725 J01T1 DRAME,1,311ZtTZ4A
=101113 IDD CA 92025
117X.'r14'31X' ”" 11.T CA. 92260
(760)340-9000 (SW 00353
USE OF PERMIT
N -WL. X11A
POOL A`Nf) N;P.A. V0UR*MN . FIREPIT 496 :�iaA2 wiQ 121 m.1995
I MWIS1�MP,1ziERS %1ALL FSE tit' PL CE PRIO12 T O Pfif:f LA,.;E'iER
T.NS!}Y=IOii. POOL ZQ1.11h OhZNT ENCLOSURE -NOT YNC"L,1JDED :114
L'LWL ANDIOR SPA 26A,0,00 LZ
A�
4'1MD E170ST OF (,10149MM""71lox
Y�yq��p�yV,TI'1
13.�6.1•9.��i i3 VA�i3Mi.[i.LT. ]C
FLIM C1. .K FES 1011-000.439.31 It 308,E
COWSTRI 01710111 �' = Y t31-CZC 4? f�-Ctt3i� .5iF
Ay�q�;;ir,;+�,µ".1il�Z. FOY,-- P00%1p.1000 *.+;���i
. 101-000.4,21-000
1:.bL'+iw�7� KII� L CPai�-'... ru),L L#.?-*Wi71
£:°1X.1MB11.10 FEE - POOL 363 iSQ-�1$� �
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FEB 2 f 2001 b
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WYOFiLAQUIMIA
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R. �./ �i��,1�1 PER.C!!Y.i. ' ��� .!!.i -S h7 D L E .l'!O Y'Y W'a�af�AU 3
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RECEIPT
DATE
BY
DATE FI ED
SECTOR
p.,
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 Wall 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
Underground Electric
Underground Plbg. Test
1 12
Final
Gas Piping
Jz
PLUMBING APPROVALS
Gas Test
Electric Final
7.
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
Final
Utility Notice (Perm)
COMMENTS: