0002-427 (RPL)�.�.;,.•
� •"` I LICENSED CONTRACTOR DECLARATION
�L 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
04 W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
O d 6`�{3tiaJ } UJ�J1�(}i
.' LJJ r -
f` lY �
o Z Pate 1'4 "Signature o`Contractor
O OWNER -BUILDER DECLARATION
H UI JI r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N 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).
cY) () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
O�
Q WORKER'S COMPENSATION DECLARATION
C) (r I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w compensation, as provided for by Section 3700 of the Labor Code, for the
O - Q performgnce of the work for which this permit is issued.
m Q U I have and will maintain workers' compensation insurance, as required by
O C) Q S eftion 3700 of the Labor Code, for the performance of the work for which this
OL v Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
Cb d STNIAll MiZD 03.5.90142
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
subject to the workers' comperis'ation proy si nns ofof Sectio .3700 of the Labor
6ode, I 'Shall forthwith omp'ly with those proVislons.
(Date: pplicant/
f t
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
ICYof 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. I
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 C_ ity, and State laws relating to the building
construction, and hereby �autho a representattiives of this City to enter upon
the above- mention ed•pfopeerrt'y�for inspecti�.purposes. a
gnature (Owr",er/Age t)_Date - �(I
BUILDING PERMIT BUILDING
1;!l3fljri27
DATE 02/2-40200 VALUATION $10. NO.(") LOT tip TRACT 75399_3
JOB SITE
ADDRESS IS -%i C:RA1�1D T4aZ/;il'ER.�1 .:�Z�ul Iii
APN 169-050-008
s
OWNER
CONTRACTOR / DESIGNER / ENGINEER
It Pr fN%rr: r��Ehj't S. nm c,
R1`'i`•IW/ESj"i Q1: At''1 S, INC.
W425 E. UNIVEitS.l.i Y DRIVE
1421 E MVERSITY DkIVE
PHOENIX A% 8.'W-4
hizOPNiX. � AZ M2!Wt
1E02)257-t� CTRU# 4 0
USE OF PERMIT
P001, .aA1IWOR 10A.
001, Ar SPA ONLY - r'ti.,i12 4SMARRIUMS SAALL BE IN ENLACE AT FRE.. \�
VLAS` 1R 1NNzP. (,T1GN
POOL .A,I4Df£OR `PA 10,000.00 L
i{.n7• ra.t+x:[4.LTED C'013I OF CiliRrsb'ia .U.,C . ON
1010:.YO.90
PE, RKIT PER SIM i1IARV
PLAN CHECK .h E6 301.-04)0-439-318
f,�"t 1i'+£S' RT -T M0N FFT, 1,00 -OW -41.8-01
;V�,"�.,C'JAk-1; CAL : M .-' V00,L 101-000.14w 1-000�-
ELECai2IOV. K -_ POOL 10i.-000-420-000
_._.-PLUNIStjt(3FIFE --POO), .10.1. -000 -141.9 -OW X17. J
3is
•t'.^5
4e
`1)R-1CtJTAiV C'N1�Cb7.£(.tlt
LESSiE:-PM., D FE.ES
fiO,Qil
. i
T0TXL PERNITU FEES DUE NOW
S299191%
RECEIPT
DATE
9Y i
DAT LED
INSPECTOR
INSPECTION RECORD
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
c�
Set Backs
Electric Bond
q�(
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
of
Final
Gas Piping
- C41
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
_ r/
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:
'.
.48.:20
PAD--47.7 __l%
PLAN'..2A
yIN :
1 . r} - . - � Imo` '.�.• ,� ,
A 7T
301M X ; 321S AVMIIIdS
ar d01 IIVMWVO
d31SaIV V61WV0 66 -
.LZ .bZ .22 S1V3S 13 31 la —
S11VM OOl 3111
_.81+ S3A 03SIVU SX[ 3215
21.'1 2 d31S
TI Z LSvn N310HNl0S 301 n30
UNV ,
2lbO11)i:)01:) M 0 1 l _ � .. . •, ; .. .:'�;.: � 7 .,�.,:. d , ., w�;�.:;.• • ,;:, •
A `R INSPE ION FEE $ 0
CT OF 3
pQ, WILL SE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE {:SIT
E FOR A SCHEDULED
INSPECTION:
.; ::: ANO EXCEPTIONS!