0105-006 (RPL)BUILDING PERMIT PERMIT#
LICENSED CONTRACTOR DECLARATION
C/)
I hereby affirm under penalty of perjury that I am licensed under provisions of
t—
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W
Professionals Code, and my License is in full force and effect.
M
License # Lic. Class Exp. Date !
dLO
57412? A C13111C ,. ��:� 101
Z r --l
Date "y Signature of Contractor
CS
U coo
^- OWNER -BUILDER DECLARATION
HLU rl-
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
&>i�:11..�SI'.�� a,R.I,.P�ii��i1B.u3.1�,3�1�",Ir'.:' Afii.3�;'P �iL i.�•3 $�'C..l."J..�:�.r'4.`C F�'��?t�7��`l.'?'..�°. '
License Law for the following reason:
Z(
) I, as owner of the property, or my employees with wages as their sole
E'SI`!'.f�da�Jd.UM OF CC?.MMKI C°,0011
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
PLAN C:HF;CK YU, 101-0004.39-31 a $163.80
( ) I, as owner of the property, am exclusively contracting with licensed
Od_Nh'ITFc.? Ci'1txNWZP 101.-000418-000 $253.00
contractors to construct the project (Sec. 7044, Business & Professionals
&C:t t` NICAi. FRE4.-- 'POOL 101-000-4214100 S2A.0Q
Code).
C'')
ul
() I am exempt under Section , B&P.C. for this reason
O N Date
Signature of Owner
o)
d Q
WORKER'S COMPENSATION DECLARATION
p
1 hereby affirm under penalty of perjury one of the following declarations:
p
( ) I 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
m
performance of the work for which this permit is issued.
Q U
6v# I have and will maintain workers' compensation insurance, as required by
dU Q
Section 3700 of the Labor Code, for the performance of the work for which this
insurance &
0 Z
permit is issued. My workers' compensation carrier policy no. are:
cw 5
Carrier Policy No.
ik`1:J"s'3'E K13,110
DATE FINALED
INSPECTOR
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 •l should become
subject to the workers' compensation provisions of;Section 370,0 of the Labor
3
;
Code, I shall forthwith comply with those provisions.,,"-
Date:._.`S-.. <. Applicant ✓'� �:�' •'� •' .. ...�
L•
_War•riing: 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
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
4
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 for inspection, purposes.
Signature (Owner/Agent), .%'` ` r� ="`'f Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
IV 1 rva $24, AV
JOB SITE
ADDRESS
Ail' `y
80-M
OWNER
CONTRACTOR/DESIGNER/EN (NEER
1917M WAXIMHON28
9.1MDCsDg:ON (M1w:3 IRIJ� "!71ST roc,
7151 -WAAbl &AVE.
73011 COMM C1ILM Dr„ i7u117F41
I?1TYRSIME CA -22304
'PATIM lwaa CA 92260
USE OF PERMIT
FOOL AMOR �
&>i�:11..�SI'.�� a,R.I,.P�ii��i1B.u3.1�,3�1�",Ir'.:' Afii.3�;'P �iL i.�•3 $�'C..l."J..�:�.r'4.`C F�'��?t�7��`l.'?'..�°. '
IMM -TION POOL NU)M1;x+12" R.N(1 /J'.T0R.E?H0T Mt..T.iJt ED,
Pt;M.,ANNOR SPA 74,360,1110 E$
E'SI`!'.f�da�Jd.UM OF CC?.MMKI C°,0011
PLAN C:HF;CK YU, 101-0004.39-31 a $163.80
Od_Nh'ITFc.? Ci'1txNWZP 101.-000418-000 $253.00
&C:t t` NICAi. FRE4.-- 'POOL 101-000-4214100 S2A.0Q
EIL.iX7'dTlC.AJ, ME •- PCOL 101-000-4204)00 145.00
PLUMBA40IrI F,.. P00110 101-WO.429.000 $27,00
A4,1%9MAN ClMi:`K,
b1.5111M
UDS PYO -K RAW 1:, S
Q
D �
.11M Oil
X
.
U j M AY — 1 2001
CITY OF LA OUINTA
IRECEIP_T —_.__r._.
/ BY
DATE FINALED
INSPECTOR
1, -!r,r
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 Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
_
_ S/2�/6 -A—
Footings
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
PLUMBING APPROVALS
Underground Plbg. Test
Gas Piping
Gas Test
_
n�
aC
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
z .
Gas Test
Appliances
Final
COMMENTS:
17
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtu,rs
Main SErvice
Sub Panels
Exterior Weceptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)