0101-222 (RPL)U)
i-
N_
W
Ouch
r--
' W
Z ��
CCDD 0
H(D
IW— W rl-
I)
Z
CY)
LO
N
ON
U °)
Q
Z
Lo
Q O
XW L=
J.<
mQU
O. U. Q
Z
Ob 5
V
Q
J
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
,Date ;!- 11 A fr Signature of Contractor „.4?, 1 J !^_y�
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.
I have and will maintain workers' compensation insurance, as required by
5%ijtlon 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 Policy No.
ST;kTit FUM
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) (:certify that in the performance of the work for which this permit is issued,
I s -hall 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 withothose povi ns9
Date:
Warning: Failure to secure Workers' Comp sation 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. Y AlH
IMPORTANT Application is hereby made to the Director of Building and Safe!
for. a permit subject to the conditions and restrictions set forth h'
application. J ee k.
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: or inspection purposes.
/}�
Signature (Owner/Agent) i! q DateZ',72-0
Y-
( BUILDING PERMIT PERMIT#
DATE l / VALUATION LOT ®ai�fd TRACT
JOB SITE
APN
ADDRESS
M. GA1rAXY D: IVE
OWNER
CONTRACTOR/DESIGNER/ENGINEER
INIA VALMOS
Cf.UFGitt iAPt'rO:f 9 &SPAS
L'A QL'WrA 4rA 9`2253
P.A42A IMPERT CSA 92260
(760)340-9000 Mut 5386
USE OF PERMIT
PO01 1- ASW&:tR iv' h
POOL & Sf .A Ol+li.:Y'_.r L 1:M:n1k.MXRS a1iALL. BE fiN P;..AC:F; AT ?SRI
1'L/°bSTER WHWI CR 3SsA1'i.;�011, EQUIP:MYNT ENC1,031 RE 10 3400 iNCLAI1.7ED
1�1 THIS PERMIT
PCN)),. NWC, R 1311A 1 ' 09.001.2
PLAN CHECK FFI? 101 -E300.439.41 8 ! 7.00
C;UNSTRUCT ION 01 _000A 18-000 � ast4�J.G0
MkC>!'YNNtd.,6IL RM -- P001, 101 -000 -421 -OW �?r1,ilU
1 s.ACTRICA.,i.. FER — POO 101 -400.420 -WO
1sLAI MlS)"l 0 tx' R --1.a0 L. ;• 101-000419-000 MAl
6
2 2 2001 --
0 17 &.8
'
RECEIPT
DATE/ l'
BY ..yam
DATE FINALED
INSPECTOR
1 /-.7
OPERATION
DATE
INSPECTOR
OPERATION
DATE 77F7INSPECTOR
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
l-(
Set Backs
Electric Bond
/
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Electric
Underground
Underground Plbg. Test
Final
Gas Piping
co
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
�J
COMMENTS:
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)