0302-193 (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..#a q c Lic.�Clla}s�s Exp. Date
�hy
Date °S Signature of Contractor
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
-( );
.1, as owner -of_the-property,_am exclusively_ contracting_ with licensed.*,
contractors to .construct the project (Sec. 7044, Business & Professionals
Code). /
O I am exempt under Section B&P.C. for this reason '
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under' penalty fiof perjury one of the following declaration§i
( .) 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.
(4)-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:
Carrier j`;�'ATEC'0-1APZi MTJ Policy'No. 0464:10-2003
(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, lshall forthwith comply_with t se pro tsions�
,Code,
w '`> '_ Applicant- 7 '� ;� '
oma' r
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.
F A
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 propert or ins action purpo es. ,
Signature (Owner/Agent) ? Date
-.=BUILDING PERMIT PERM&T#
-
DATE .' ; :-'VALUATION LOT TRACT
JOB SITE
ADDRESS «°1-2'� (..
APN
OWNER
CONTRACTOR/DESIGNER/EN &NEER '
iNNOVREVE RESORT i,10, MW YMMES, WC
CA1131-KANl'AV10OU & PAS C,10P M N CO
0C� �.. i�1:��T'Ia.��T�Y �x� f�1 t9i3
��fS. j �t1 A �, � •
ESCONDWO CA 92025
COACHILLA CA 92236
00355 '
USE OF PERMIT
P001 -AI N, f S .L. YK 5'BLOCK 'fid, U., C.t°rY a CAND,F RD.
n03
�y�SXe a 00 tk7
U
OOL• AR J f. R SPA 1.'1pei.00 ;tS. 'LNANCEDEpT.
Y OF LA QUIR}Tq
PLAY 0MIh FFM IM -000.439-318
CONSTRUCTION,FEE,101-OIDO-419-OQO �I9fI,ia3
I+AEC;J" 1i1d L ME POOL .._ 1011.000.421.000 $24100
9b.19cTR1CA,L FMr — POOL. 1101-000-42D-000 $45.00
E lAYBINGRE— POOL'. ' 10i -W0409_000
. � i�E.7}3:•`t:'L"3•'3"�alo.l.;�_6.'I.)�:'�;fft��� �:k�� 11?�t��F C,"!t'':.1�
✓�.:1�
RECEIPT
DATE
BY ;
DATE Fit LED
INS E TOR
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
PO LS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
_
Footings 03
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Kiste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final 78/3
COMMENTS: y.A
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)
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