0201-206 (RPL)LICENSED CONTRACTOR DECLARATION
�I hereby affirm under penalty of perjury that I am licensed under provisions -of
Chapter 9 (commencing with Section 7000) of DiAilon 3' of'the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
656128 C, Z FIM CuS
Date. ' f' Signature of Contractor i
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the'following reason:
( ) 1, 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 8 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
hereby affirm under penalty of ,pedury 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
iorr3700 of the Labor Code, for the performance of the work for which this
permit. Is Issued. My workers' compensation insurance carrier & policy no. are:.
Cfurier . �1 ! hp� l 1r A y Policy No. Q
046-02 +up
0006168
(Tfiig;section need not be completed'0 the permit valuation is for $100.00 or less).
;:(Y;) . I certify that in the performance of the work for which this permit is issued,
;l'sliall 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 nyse provision
Date: Applicant ? ,9
.tr
Warning: Failure to secure Workers' Compens ion' Coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to.$100,000, in
addition to the cost:of compensation, damages as provided for in Section 3706
of the. Labor Code, interest and attorneys fees:
IMPORTANT Application is hereby made to the. Director of Building and Sefety
for a permit subject to the conditions and restrictions set forth ori,�his
application.
1. Each person upon whose behalf this application is.made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, &,shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of ;such.
permit, or cessation of work for 180 days will subject -permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply, with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City -to enter upon
the above-mentioned property f I spec�ion purposes.
f
Signature (Owner/Agent) l I Date /' 2!2.-
{ ,1.
--BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0201-106 TRACT
JOB SITE APN
ADDRESS�� g
OWNER CONTRACTOR / DESIGNER / ENGINEER
I'& qli:ibl' tk mC.' mu) irAWi-Io2;a t—A&IIURNIA P001.1_.Z &. SPIW (17011 tdl_I Y4 0-03
'l9. 295 R;-' NCTIO IJP QjANTA 1)R, 4725? J0111 t: R.11?;C,T ,9Wf.-M #A.
.Pi T)T1d P;` ; •
CA 92253 1;'.ALIA KXI+"s;3EM,7s . CA 92260
(??)340.9000 u:611 0035
USEOF PERMIT
E'(3OUVA12NDPER
ON(AN 1�,1:`,P.K) CA14 `1T'LJ~.4. A1..ARIAS 4,1?A1tf4iMl MIS`( 11F f'14 Pi-,
VARIr:1R TO I°F?F-Pt.,,ASTVR INSPYC.`'i IGN.
Pool. Et,Nt: DOR SPA
12,11if,00.00 1.11
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2911SMVP
P.lq�t't:NdS.'.f TsIX, Fi1:1KH:t$:r Y
P1.A11 CHECK FBE,
101-000-439-318
$ 4,p3
CO MSTRUC'rlf7N Jri? F
101-000-418-000
UKAO
P1,11.11J1i3YNG ME
1101-000.419-000
MUM
will, HJ11 1CAL i'14li': POOL
101-000-421-000
$x24.011
i(iAX,"IJUC- ,L ME .-POOL
161 -r000 -42t1"00 ;
n43,01)
1'Lt1AlJflt:ti1' F'i';� .:• f 0{�1, �-
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RECEIPT DATE /� ] BY --I D7E (/jLE�/n � I 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 Wap Insulation
Condensate. Lines
Party Wall _Firewall
Exterior Lath
'Drywall - Int. Lath
•
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond. Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
_ e 2 -
Final
Final
Gas Piping
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
,Z
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
w `
IaATRELL
ENGINEERING
GROUPS INC.
651 E. Northridge Ave. Glendora, CA 91:741 PH: (626) 335-4362 FAX: (626) 963-4812
ENGINEERING CALCULATIONS
AND DETAILS FOR
SURCHARGED POOL WALLS.
ANDBRIDGES
ESTANCIA LOT 14
50-425 HEATHER GLEN
LA QUINTA, CA
re roo..sp
w o No. C32994
a
Exp..6102
�� OF
DATE: JANUARY 22, 2002
ENGINEER:: DOUGLAS R. FERRELL
RCE # 32994, CALIFORNIA
651 E. NORTHRIDGE AVE.
GLENDORA, CA 91741
(626) 335-4362
® Project: F—e,6A.A, LSC' Qc-
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ENGINEERING Client: GIZWK
GRO�IP.9 INC. Engineer:
651 E. Northridge Ave. PH (626) 335-4362
Glendora, CA 91741 FAX: (626) 963-4812 Date: _ Z�OY Sheet of
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Giendora,"CA 91741 FAX: (426) 963-4812
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