0307-067 (RPL)i LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjurpithat I am licensed under provisions of
Chapter 9 (commencing with Section 100) of Division 3 of the Business and
Professionals Code, and my License Is In full',oree and effect.
License # Lic. Class Exp. Date
779165 ,FL33 HIC � 05131/2(
Date Signature of Contractor2 "X
r I Q
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 'is reason
-Date - a y Signature of Owner e—? f...... --r
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 STA9.E,FU)aD Policy No. 1699463-2003
(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: Applicant-
Warning:
pplicant 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 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 in pection purposes.
Signature (Owner/Agent) Date"I
BUILDING PERMIT PERMITI0307-067
y
C'1
DATE VALUATION LOT TRACT
17 1 ,9r� ,� ni3,(mm
JOB SITE
APN
ADDRESS 80_9W%n.fJSX0'FF
-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CF90AG1. & JAM POW.rM,
f
CARt03,t VD -1w P00,113
3155".CAMAY 0300
?2•.9S :, TA1AARM,
O�'•ZA.b3^x � CA.
PALM. SPPJW S CA 92262
(760)778-2700 CSI, 1.451
USE OF PERMIT
POOL A111 MIOR SADA.
POWSPA, FfBQ(AW31 ;d1.52A), AL.A13.MS1fIA,ICRIERS SI -TALL, BE IN
PLACE AT PR -PLA sTER WSPECTION, FfQUIT'MW1 ENCI-A)STIRE MOT
INCLUIDPID
POOLAND/OR D/OR SPA 30.W0,00 1's
EST.k14SA. M) COSH' OF CONS` RIUCZ70H
:�t);ftdliA.(iQI
p°LIRMT "FEE 917D/I U"Y
PLAN rFlWX FEE 101-000-4379.318 $184,93
.
C;014STRUCTIOW LEE 141,•000.438-000 084.30
MECHANICAL "M -- COOL 101.000.421.000 5:24,00
.
E.1.ECTRICJt.L FE •- POOL 101-00CJ-420-000 $45.00
419-000
PLUMBING FEE -- POOL. 1.011-000,419-000
JUL 18 't�3
TA
CFI
ANCE QEQ
19UT31-T07%F.., C0Y S1RLi`O'i7OX.F11tiD PLAIT CEM(..,
$565.43
LESS PRF_-PA3D1• + 9
$0.00
TO1'A& F1RMT I<+'31'ES ]DVIR' NOW
9;'510.43
RECEIPT
DATEBY<
"
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
`*Replace T.O.
Fans 8 Controls
Patty Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLORKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs 17
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
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: :.
-
t
CITY OF LA QUI NTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE 7-(9-0,3 BK -7 --
PIL
I
golf course
33'3
decking
1wd &TWI)
Gas
Elem
golf course
PJL
13'0 1
M ISPM Sd 0 -39*
29' Quartzite Stacked Stw, Ext -
Stone Spiltway \Ten 32& it"
!! rnite
pool 010
Wo 3
\2jO'D
40'0 -
X, beach '.
P/A
umbrella sleeve
43'4
"-4 3/
23'.5 44'0
.47*2
24 '0
LOGGIA
PCOL8055
REMOTE 5'M17CH
G/E RESIDENCE
GEORGE AND JAN PORTER
F SN91-70 WErSKOPF WAY
LOT 36 MASTIER 5ERIES PGA WEST
ob�cacess,
L
LOGGIA
7W97&1700 ' 760-320,3667FAX 2295 East Tamarisk Road - Palm Springs, CA 92262 - License Ni
s. 779165