9608-003 (RPL)LICENSED CONTRACTOR DECLARATION
W Lhereby affirm,under penalty of perjury that I aiTr licensed under provisions of
Chapter 9 (c6rnmencirijyvith SectioV000) of/Division 3 of the'lBuginess and
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C\I LLJ Profe'ssionals'Codej, and my ricense-is-irflf-difforce and effect.
E) Z) C,) License # Lic. Class Exp. Date
r" LO 0 650M 10131196
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Z r� jDate -V" 2 Signature of Contractor
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(0 P: CY) OWNER -BUILDER DECLARATION
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LU LILl (0 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 1, 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
QJ I AM 6XMI60t Lii)d6f S66ti6h —, B&P.C. t61' thig MA96A
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C\I Date Signature of Owner
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< WORKER'S COMPENSATION DECLARATION
C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
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F2 0 1 have and will maintain a certificate of consent to self -insure for workers'
X UJ compensation, as provided for by Section 3700 of the Labor Code, for the
m_J < performance of the work for which this permit is issued.
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< 1 have and will maintain workers' compeniation insurance, as required by
(lety,on 3700 of t�r I.abor Code, for the performance of the,work.for. hic I h this Cj Se e
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LO permit i,, 1TArkers' compensation insurance carrier
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`t z Carrier Policy No.
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< (This section need not be completed if the permit valuation is for $100.00 or less).
I certify that in the performance of ifTe 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
.17. ' . t, I f I, /
subject to the workers' compensation provisio s Mection 3700 of the Labor
date: A p
Code, I shall forthwith comply with;hos
p I i ca rit, Do - Yr;r?7Y1,
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 p&son 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
trpospermit, or cessation of work for 180Aays will subject permit to cancellatiorf.
I certify that I have read this applic,q/07rand state that the above information is
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correct. I agree to comply with all City, and St�te laws relating to the building
construction, and hereby authorize re regentatives of this City to enter upon
the above-mentioned property fdr ins ctlo , e�p
es.
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I/Signature (Owner/Agent) e,I Date
PERMIT# CONTROL#
DATE VALUATION BUILDING PERMIT, .3806
Of f/96 Ujill)IIIIIIIIA0 LOT TRACT
JOB SITE 4
ADDRESS -715WENGED FOOT APN
OWNER CONTRACTOR/DESIGNER/ENGINEER
J!�- 1*Asr-+1 CALIF011NIAPOOLS &SPA.S'
41910130AKUWALK #A2
,,,A.(WfhFrA ON, 9225.3 PALM T)F.SE*Wr CA (,"MO
(519)34()-9t)00 C81 -ft 355
USE OF PERMIT
VtLXAANLX)R,,&A
SRA0NILY
PLAN MECK f8#?
0CNN3TH'1Ir_1110_. tq FF -C. i0i-00-418-000
N=HANIC,AL FEE — POOL 4014*421-000
f,'-IY,CTf0CAJ, VEX: -- KA)I 10MM-420-600
PIJAM11NO FTpl — POOL
RECEIPT
SUB-TrfrAL, coNsntucnONAND PLAN C1111ECK
LESS ME'.-PAIDVEES
'14,0M, P0,1114MI'I'VEESOVE NOW
DATE By
DATE FINALED I INSPECTOR
4. 6,04m.00
$229.65
$0.00
$229.0
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
POOLS - SPAS
steel
Set Backs
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:
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