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. 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
61461.1 C53 _111i;07
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:
( ) 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 licens ed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
I -am exempt under Section P&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-insore 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,
Secon 3700 of t �� e workifo . r which this
?,.Labor Code, for. the performance of t
twii 0
My workers' compensation insurance
permit is IiOlsul 41-, c,46PVp9blicy no: are:
Carrier Policy No. 7
(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 oVection 3700 o
Labor
Code, I shaji foqhwith comply with tno�e VISIO
Date: Applicant—
Warnigg: 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 hi's
application. . 4
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 rep�esei�afives f this City to enter upon
the above-mentioned property for insDect . pu ose
'Signature (Owne�r/Agent) W_,e' Date ))4Jol
PERMIT # CONTROL#
BUILDING PERMIT 9607-11.8 Q . A
37W.
DATE 7/2-9196 VALUATION S1010.00 LOT. TRACT -,T
JOB SITE 79400 FOX RUN
APN
ADDRESS
I
OWNER
CONTRACTOR DESIGNER / ENGINEER
MCNITRI, M,)LS'& SPAS
_50443 MOUNTAIN S11M)OW & KO,
46301 ROUDE 1, LANE
LA QU[M-A, 42A 92253
LA, QIAffrA C A 9,-. 2.5 3
CRU .1945
USE OF PERMIT
POOLAJNDA.M. 8PA
P001, AND -SM (YKY
E ST1A1;XG',0 01ST OPCONSTRUMM
-14,000.0
PLANCHECKIIIIM $99.,15
NVE.n, i A1411C A ' 1. K11L. — PO (X 101-000421-000'
)0
PLUMIAI.NCI F 6 P00L. 1011l-MY41 -1 0
S0'11_1YYfAL CONSTRUC710K AND PLAN CHI"CK
$118-45
LIP", S 8 P PJ 3 4) A I D F !'H'E 5;
$0.00
I , 0I 'Xf, MR441T FETSIME NOW
ip
S348.45
I JUL 31-1996
RECEIPT
DATE.—, I
T� D
INSPECTOR,
t . . .
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
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
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Aporoval 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
COMMENTS:.
Final
LIfility 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)