0206-087 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
or- p u7 656128 X153 WIC C_� 10 31/2(
LIJr � I C..iip. fr ! A�
o ZO � Date � � Signature of Contractor— AO ---
✓K ,
CD �
J U C:) '-^ OWNER -BUILDER DECLARATION
HLILT I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z( ) 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).
LO () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
(A
Q WORKER'S COMPENSATION DECLARATION
p Z 1 hereby, affirm under penalty of perjury one of the following declarations:
HCr
Q () 1 have and will maintain a certificate of consent to self -insure for workers'
X w tL compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O 0.:
S ction 3700 of the Labor Code, for the performance of the work for which this
ti Z permit is issued. My workers' compensation insurance carrier & policy no. are:.
Carver ISTATN CM1'F,i`3'�ATT Policy No. 040100616M!
w2
�p
J
(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
1 subject to the workers' compensation provisions of Section 3700 of the,Labor
•�••i7 Code, I shall forthwith comply with thoSre provisions.
41
Date:�"• �% Applicant
Warning: Failure to secure Workers' Compensation coverage is ul and A
shall subject an employer to criminal penalties and civil fines up to
addition to the cost of compensation, damages as provided for in 3706
of the Labor Code, interest and attorney's fees. II,�
IMPORTANT Application is hereby made to the Director of Buildin and and
for a permit subject to the conditions and restrictions set f h t
application. FIN
1. Each person upon whose behalf this application is made .& eac
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, k shall, irjdemnify
& hold harmless the City of La Quinta, its officers, agents idnd 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 purposesI .
•�••� Signature (Owner/Agent) afg /1� Date
W 11
v -BUILDING PERMIT PERMIT#
0206-087
TRACT
DATE--' /. anix VALUATION tv,=.w LOT 45
JOB SITE
ADDRESS 444M, F iAUXI G'C?URr
APN - d
OWNER
CONTRACTOR / DESIGNER / EN (NEER
C lTt1ily CiiOWL"L . COIvIEaiLT3 TES
C,A3.,iEYUM41APO IS & SPM (f OP NWW CO:
1535 30, 1V M=U. =0200
74 y Z5 XM D12YVE, SUM. 9A.
SAW B EWA.Ft.114 6 CA. 92408
PALM M D uy^" RT CA. 92260
(760) 140.9000 CHL;A OoWk
USE OF PERMIT
'AND L AEkMR SPA
P'0O1 SPA, Ai.tAFiP+.:V3 AFJ,11ZAS .;HALL BE IN PLA,M PRIOR TO
PRE -PLASTER 111SPEC'E IOR
POOL ANDIOR S PA a /it7YW L1+ 11}
:.+ ". "IXV COYIP OF CrOXISTRUL;: ION
17,SMOD
PLAN CHECK Isla 101=00014SP-3618 - 51.2119.5
CONSTRUCTION M1(Jg-i1a)Ctaei'kf�-41x)0 �aiSg:133
4�i 4:IrEdk?1I("A? , PRE -- TyPOI, t 01 rtltSt�s4�,E �Qt)rs ��G.i1�
E;;i.' 'E'ftICAJ. FX- POOL . 1,01 -000 -420 -NO V9i„itt<
P1.;EDMB.Ikl0 FE, F o. POCA, = 101 -M-419-WO
ILAQUNTA
91 4i1 AL001,MT'RT.ICTIt:ON. AM'PLAN C;`I-T.CClC
ISM 1IRL41AID FM
$0100
'IyC.?TAL P 'ji',J X 1M-5 DAM, NOW
�• �,f�
RECEIPT
DATE
BY
DATE FINALED
INSPECT
RN
61:j M44
e O
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 8 Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lech
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
—aZ
Set Backs
Electric Bond
—f7
Footings
Main Drain
—p
Bond Beam
Approval to Cover
Equipment Location
Underground Electric 2_._ p—o
Underground Plbg. Test Z=12.p
Final
Gas Piping
2—
PLUMBING
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: