0110-305 (RPL)U)
F–
N U)
W
o Q �
W
G Z ti
CD ri.
r– P: o
ww�
I— CL
U)
Z
co
L0
N
0 N
Uo
CLs
Z
`rQcc0
XLuLL
m<Q
O
a LO
�Z
aD 5
I\ C)
\!
LICENSED CONTR,+CTOR DECLARATION
I hereby affirm under penalty of'perjurythat 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 # L'ic. Class t Exp. Date
Date f , j Signature of Contractor
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).
( ) l,- 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&RC. 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:lconsent.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 maintainworkers' 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 STATE CtrMPENS,ATF Policy No. (AO06168
(This section need not be completed if the permit valuation is for$100.00 or less).
O 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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with tpose provision .
Date: /�' � 2-6Y Applicant
r
401
Warning: Failure to secure Workers' Compensa ion coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up'to $100,000, in
addition to the costof compensation, damages as provided for in Section 3706
of the LaborCode, 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 Duinta, 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.
1 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;#oins'pplotion purposes.
Signature (Owner/Agent),A?-1 �%" � � �� E' 'r` Date ' 'f `•j %
PERMIT #
PERMIT
,,BUILDING
DATE VA,lUATION LOT. TRACT
JOB SITE
ADDRESS i�.2-s�. rAf�FC;O)Cb' ��J� A
APN —
OWNER
CONTRACTOR / DESIGNER / EN (NEER
(I'Mi'i"CIRY (!RCAXa,L GC7rlu9MiiMME21
OP I.Xr<;l RNIA P001Z & VA.-, M31 Fv4;E'-.N C01
15:35 UX "Do VMXEL llfll. 0200
74775 JONI U:[GVE ZRTLTr.l'E #A
SAN AlRtE1'YMINC) CA 92408
FA7'1MI)MIRT ,;y� 9226{)
Q00)340 9000 C''I 41 003,55
USE OF PERMIT
11001. d'iP1T IDR SPA
P'OU, &PA, A .R , i"AJtN..iirR'S' .I'MAL , 81?, [N Pli,A.CY .t' RVIPLAS L is
4�i R'L�C'I`sc>la, iia t.F; n6� g' HEtc7�E 131 €D4 1* iATQ4i.J,, CI o'Y STANDARD,
POOL J1;N1XOR SPA 1.3,000.00 LS
5 FT. WALL 1R.t3D l.,.F'
PERA i'T EVE STJ 'kW
Mal CNFXK FIFY 101-000A39-:316 Sld8: 7t1
CO)4SyTRUCTION FES; ` 109-000-418-N.10
1�lJF,C, 4ANICAlt In,. — i'C}t~A, 141.000.42.1000
1:1.(i:C°'d-air.,AI., Ira, •. Pi' o). 101 _000120000 ': $45.00
P1.131rh1E I @C 147 — POOL ; 101-000.419-000 $37.00
II,� C4AV ®
tool
• 'iii . ; ..
.,
SUB-TMA1„ CON�')�iLJf:�TT(�3�1 4 . i r f"1i�.
$42.2.70
LE34, Ti`Ft
TMAI, MUffr IMES DUENOW
9422.70
RECEIPT
DATV
BY
DATE FINALED
INSPECTOR
MSPECTM RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDPNG APPROVALS
MECHANCAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX 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
BL®CKWALL APPROVALS
Stell
POOLS -SPAS
Set Backs
Electric Bond
Footings
Main Drain
Approval to Cover
_
Bond Beam .tel
Equipment Location
Underground Electric
Underground Pibg. Test
%f. �QJ�•�/
r
F;nal
PLUMBNG APPROVALS
L*aste Lines
Gas Piping
Gas Test
Electric Final
Heater Final
c
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
MIN Notice (Gas)
ELECTRf CAL 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: