0005-165 (RPL)LICENSED CONTRACTOR DECLARATION
affirm under penalty of perjury that I am licensed under provisions of
9 (commencing with Section 7000) of Division 3 of the Business and
mals Code, and my License is in full force and effect.
Lic. Class Exp. Date
Signature of Contractgr,
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 toi construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section a;-B&P.0 or this reason
,Date rG/f '� Signature of 16wner f
'`- 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
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 Policy No.
(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
6ubject to the workers' compensatipl; provisions of Section 3700 of the Labor
Code, I shall forthwith complyw ti h those pr-.ov�e��i0•hs.
Date:P�+ 25V Applicann
Warning: Failure to secure Workers' Compensation cev/rage is unlawful and
shall subject ar'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 iso
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
theAbove-mentioned property/ -for inspection purposes.
Ignature (Owner/Agent),�'z� , Date
BUILDINGRERMIT PERMIT#
DATE VALUATION LOT OCQ-165 TRACT
SW,fitlt3.fP0
JOB SITE
ADDRESS 413-91M GIMOA D.�,1W..
OWNER r"
JAMW &. ROM ARMS'1RU;1 G
43.900 03NOADRI E
LA QUINTA CA 92.
?.53
USE OF PERMIT
POOL ANDIO 2 SM
APN
CONTRACTOR / DESIGNER I EN (NEER
OMMEMUTMER
4.3-900 C*1:;NGrADRIMB
LA Q�M444TA CA 92233
(760)360-9249 MIX
POOL. & SPA ONLY- AI.A ::MWEARRIERS SHAU HE 114 PI.A.Cl?,.AT PRE
PLASTER Tj SPFCTIONYOOL EQUII'MM ENGlAMUR AI0T INI CL JDRD IN
THIS PERMIT
PQOL ANDIOR SPA
1090.40 Is .
ES'nN9A7XD CONT OF C 0A'.1rR1D'CTSiiX
10,t oom
MAW nME SUMMARY
PIAN CHECK 1:E'E
101.;000.439.318
C"CCNSTRUCTION FEE
101-000-418-000
� $111.00
MECHAVIC&L AEE •- POOL
101.000.421-000 -
$24.00
ZLL?CTR.IC_kJ. IeEE -- POOI.
1.01-000.120"-£100
30.00
PLUMBING FIRE -- POOL
101.OW-419-000
$27.00
I SUB -TOTAL CO.NSTRUC71014 AND PL" CMY $284.05
1=5 PR941AM FNES $0.00
Ij
RECEIPT DATE I AV DATE FINALED IINSPECTOR
INSPECTION RECORD
.1
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 POOLS - SPAS
BLOCKWALL APPROVALS Steel op—
Set Backs Electric Bond
Footings Main Drain ;.
Bond Beam Approval to Cover /J
Equipment Location
Underground Electric
Underground Plbg. Test
Final Gas Piping s
_
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
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)
ITY OF LA QUINTA
JILDING & SAFETY DEMI
APPROVED
FOR CONSTRUCTIO
E BY k
i
0 f 5'-O•
0
r -
A/C COND.
UNIT
BELLA VISTA
87'
87'
PHASE I
A U-M"tCMN RE OF $30
W( K COWED If THE APPROVED
JR CARD ARE NOT ON
WQM.
SCALE: 1/16•=1"-0"
LOT 25