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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 i� % Exp. Date
743118 B Ct3 A WC
Date Lt� '^ / Signature of Contractor
OWNER -BUILDER DECLARATION.
I hereby affirm under penalty of perjury that 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.
\(I) I 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 ST,&T dT Policy No. 1wtF}1✓�!3 Q
(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 s'das to become subject to the
workers' compensation laws of California, and, agree that iffI sFiould0?b- orae
subject to the workers' compensation provisions of Section 3700,ofithe Labor
Code, I shall forthwith comply with those provisions:
,.,Date: Applicant—
Warning:
pplicant 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.
h
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 pu/rposes: f,
,-Signature (Owner/Agent) �''-' Date 61 -%
Bt�ULDING PERMIT PERMITN
a
DATE VALUATION LOTTRACT
JOB SITE41
APN
ADDRESS 4 tl {!�%ri. +Bq ICOUl4.�7+ i
OWNER
CONTRACTOR /DESIGNER /EEN 1NEER
y<ryROlND
JP ENAUSILL7i
44.661 n, UUTTC1ATH COL�`T'if'
45.260 P -'Y
7.F. QUIN A C.F. 92 253
TATO CA 92201
C76Q)347.8913 Ct'•1:A 49913
USE OF PERMIT
POOL A1ti D/OrZ V A
y
POOLAW.. ALAS SISAAI EM s; ALL 3914 PLP..CM F3T J )ZE-PLASTER s'
+
w•
H'ldc"3IOly,t7tt�&�NTf2Ff'iCt�itA�3;'iNCl�tilar13's`;+
OCT
FOAL. NDIOAS11A 17,100.00 LS
9 4 100002
Clry OF L,q
Qu1NrA
FINANCE
DEPr .
lw, mlm C( M, war CO. yrRific-11iO.T.1,
171109M
PLAN CHECK FEB 101 -OMA 3:9«�18 a $122.05
`
C:C)1d;;Z'RUC3,11ON E: '101-000-4119-000, $t 4.tFtf
FEE -- POOL 101 -00(31-421-000 1.000 VMS
13.t,9C9 RJC.A.N ,,Yf-9 — SPOOL 1,01-t'TGO-42,0.000 �3,i16t
1'L:uh�ttfti t P%E -- F'�Ol:, 101 -000419 -OW
SdJB-2°OTAi, AM PLAN CFW,(7,
$407.85
12 3 FIRM -PAID IM 3
$0.00
RECEIPT
DATE
a - C• <
BY f �,.
RATE FIN D
INSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs I I Underground Ducts
Ducts
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 Wall Insulation
Condensate Lines
Party Wall Firewall
_
;Waste Lines
Exterior Lath
Water Piping
Drvwall - Int. Lath
t Plumbing Top Out
Final
I Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
steel
Electric Bond 7
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test -b y57
Gas Piping
PLUMBING APPROVALS
Gas Test �®
Electric Final
_
;Waste Lines
Heater Final
Water Piping
Plumbing Final
t Plumbing Top Out
Equipment Enclosure
` Shower Pans
O.K. for Finish Plaster
Seaver Lateral
Pool Cover
I Gas Test
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice