0303-241 (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
1128795 C53 W D35 I Ofl IM
,Date. 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, 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. .
�( )-* have and will maintain workers' compensation insurance, as required bi
Sectiomitn 3700 of the Labor Code, for the performance of the work for which this
peris issued. My workers' compensation insurance carrier & policy no. are:.
Garner rikiti iJAdi3 Policy No. 163502.101?
(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'p'rovis ons: .
pate:
Applicant-.L.�^- -
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 inspection purposes.
(Owner/Agent) ' Date"
"OuILDING:PERMIT PERMIT#
-
DATE VALUATION LOTS TRACT
JOB SITE
ADDRESS 2 7TfAp(-,1a�
�APN
OWNER a
CONTRACTOR / DESIGNER / EN (NEER
I,;f3. Q1: aNT'2 CA 92253
RANO 1+~3 MRAGM CA 92270
(760):W-2336 +SBI.# 5496
USE OF PERMIT
12P,N10DEL POOL,.A11.T),,YN0 W;ATFR FKA,` U R,ES, V2''k%?. T,t'T (Aml
POOL AAMWOR.3PA Ls.
�.e"J�'#�4 T COST OF CC?NNTRUMT10H
12.E {R3
.MAW FIM SURTMARY
PLAN CMECYP Fri 101-000--439i,318
C"C7PYS'I'T�.t3.�, ID7+Y F'�
,
MFgHANKMI FEE - POOL 1011 00.421-o 1b M100,
t Li t�%", t`t:iCC"l8ir -< PciOY. 101000-420-000 $45.00
?� PLUM INU P1X.E --POOL 101:b0t-413.4tfd} $27.00
s r
�'t •. 1.1 i•�' i
BAR % 2003.
i CITY OF LA OWNTA
t '• iv.-lJtiY'1i�M1::T: i�arv�f- X,'�.wdLLV •ISS..iYTrtYiL'a.
�� Gi7.�J
LESS 8R>-1.1AlD ,.9q.4 3
$0.00
i
RECEIPT
DATE
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
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
Final I I
Gas Piping
PLUMBING APPROVALS
EacTestric 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:
' , • ,� +24" with 3' Sheer
+18" with 2' Sheer Descent
Existing Planter
� :.
+18^ with 2' Sheer Descent .
2' Sheer Descent
+18',Existing Raised'Bond Beam w
Existing
Existing Pool
Existing Landscaping
All Raised Bond Beams
J'
,' Spa
and precise grading pla
Quartzite Veneer
''
+1 8" ire Pit
F
Golf Course side of raised
`
Existing
bond beam waterproofed &
backfilled by others
Planter
Existing Deck
y
+18" Existing Raised Bond Beam
o -
• .............................
P/L
.::............`...._.............................................
. J _ .
..............................::... ................. ,.....
O
P
Existing Deck
, : :
Pre BB
5
FSP,�doe
Bonnie Saritain
�•
56-277 Wingfoot
Existing Deck
Quinta, Ca 92253
_ nUBBLF��La
(Spanish Bay)
mgent
SPRINGS �
(7601861-1250