9807-124 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter9 (commencing with Section 7000) of Division 3 of the Businessand
N co Professionals Code,.and my License is in full force and effect:
License # Lica Class Exp. Date
cZ t— /Date' Signature of Contractor
Q
J U OWNER -BUILDER DECLARATION
W d ~ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
C () I am.exempt under.Section , B&P.C. for,this reason
O N Date Signature of Owner
rn
U Q WORKERS COMPENSATION DECLARATION
) � Z I hereby affirm under penalty of perjury one of the 'following declarations:
In 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
OJ Q performance of the work for which this permit is issued.
M Q .0 ) I have,and will maintain workers' compensation insurance, as required by
Q U Q StBcRion 3700 of'the Labor Code, for the performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carer & policy no. are:
It Z Carrier Policy No.
oD5.,.�
h,Q lit;Sl.l)%SiJ ilf�il fJV�.'tut.ttff i�
.`g (This section need not be completed if ths'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
sub'ect to the workers' compensation provisions. of Section 3700 of the Labor
de,. I all f rthw,ith comply wit h s6 p o dons.
ate: , ' Applicant
Warning: Failure to secure'Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties,and civilfines 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, indemnity
& 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 r esentatives of this City to enter upon
the above-mentioned property for in a do purposes.
/Signature (Owner/Agent). Date
BUILDING PERMIT PERMIT#
'�tidd7-1 �4
DATE VALUATION $� e.�Qi,Q1 LOT TRACT
ADDRESS
OWNER
CONTRACTOR/ DESIGNER / ENGINEER
1� �^ A r 1
I lk C1�.f�lY lil'L.A.i I.
S
l\1Ai),I ER POOLS
78-835 W HARL,tlND DR
73-i_i:! RK;HWAY 1 I i
LA.QUINI'1t (:'-.A. 92.253
PALINi DESERT CA 02260
CTIA 16
USE OF PERMIT
f►itt�)i,
fl '
K►VL 0i`1T.V ALr\Rf1• Sd7iAllA.10-6, 4 -WA. BE i1S A`1' PRL -PLASTER
1 N,8'PK' T I4.►N
i'C14:ji.. AINT %OR SPA. ; 1,0,10.0) I, ;
JUL 2 7 1998
Nfff
OF
i
10S 1 INIA'i EID CONT OF CLI1W..r,)•Rr N-1 lilt{►
rii}/Wt�.�li�i
t'f(►'0�4i�Q°! !�'tl!:F.: SiJ13l�'tlttir�tl�1� ,
N. AN CI I.fi4'iti. FERE 101-000-1139-3 18 gJe I ^N►
1�c1irl:Tfrt10TICN17VII, iO1-fNH)-418tflop $1116 ilii
at,, t?1140121 1-1.)G
POO:,
i4X.4J'1kK:AJ, H L- -- 1r0 Q], i01 -(1)0-420-W0 $4 S.00
1't,ON4131.N<_4 }:RE -- 111-:71;;31. iol-01)i)-411940) iii7_Frtl
I
0 4f-Ck
1,'30300
I..f;SS PRIL-I MI)171"IS
&0,00
'tOTAl., PE'R IAT IH'9?EN 4M:ife:'i\1ClW
:�1i3.!1i1
RECEIPT
DATE
BY
DATE FINALED
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
,Fireplace P. L.
Grills
Fireplace T.O.
Fans & Controls
Pa Wall Insulation
Condensate Lines
'Party Wall Firewall
Exterior,Lath
Drywall- Int. Lath
•
Final
Final
POOLS - SPAS
SLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Z
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
Z
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
COMMENTS:-
*Sit v 7'tii
�CL Kg
721 Av L
-
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)