0402-058 (RPL)rJ7
f—
N U
t- W
Ouch
C
' W t-
c
o Z
�0o
H�
J
LLJa
Z
M
LO
N
ON
U °'
dQ
rF--O
0 J J
mUU
O
Il rn H
ItZ
oo 5
r` a
Q.
J,
3
"4
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under prgvisions 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 # Lic. Class Exp. Date, '
6561280.53 M, C-8 1(131/Ge
Rate' X Signature of Contractor" '
' l
OWNER -BUILDER DECLARATION
1.here6y affirm under penalty of perjury that 1 "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 fo -.
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).
( ) I am exempt under Section , B&P.C. 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 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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is Issued�� My . o kers', compensation insurance carrier.& poli no. are:
Carrier uAa I 'i t,:.1"IttX-ROAAI Policy No. U�+� 3A68-s`�Yt4
(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' compensation provisions of Section 3700 of the Labor
Code, I_shall forthwith comply with tFiose provisions. j
Date: r r -r�r ,^ l✓ Applicant 1 r s`.at/.•..�
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
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, 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) - -� "��=� ` / Date' /-//—
BUILDING PERMr..�.- IT,__ PERMITN
• cAFr-tl
DATE 1/6AA VALUATION $18,6499 LOT TRACT
JOB SITE Sl -67 5 DESERT Wi ZLOW S%LR1; 'i �
APN _
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SHEIA TIOArIE5
CIIJI ORIT. A PQt:NL8 & SPAS (T'+C+P WN Ci
81.260 AVLWU'F 62
86.100 AM, 't.IF, 54
1 AQ'i,MI.A. A CA 92883
MAMM LL.A CA 92236
(760)398-9222 C u3 00355
nr s•.+x icr xat r+rav 'r r
USE OF PERMIT
P001:,AND/01<, SPA.
w+.rre -7.A. r+ar•r+t -..; Aua nnr:
e.r+.s
CITY STA.NOA.RD,p Af.f�l M2113ARRI RS SHALL bE IN PLACL PRIOR. TO
CITY
Pr1iF.PTASrER 1MBPire{" ION.
i?C'OL ANUOR SRA 12,000,01) Lu
S Irl'. WALL 30.00 LF
1,,' 1` XMD COST OF *.:C'i]`1 T RUC7 tri?R
1.0.649.50
ARY
PERMU179 SUMMARY
PLAN CHECK FFE 101-000-439-318
CCONS`PRUCTION 'FE -A 101-0001-418-000
ME;Oi3/tlICALriEE_-POOL 101-000.421.000 $14.00
ELFCTP.J('.AL FE.? -,POOL 101-000-420-000
PLUMD1140 PR - E'001, n w ... '.. Y e � u $27.00
U
FEB 0 9 2004
CITY OF LA
DEPT A
FINANCE
2YB-TOTAi~fNUC77014 AND PLA1
tQZ�In71.080"s
L 30 Jtt'CL-IAC�I�D FRES
TOTAL M#Mi'1' FT1 ES :E UE NOW
RECEIPT
DATE-2
BY =�
DATE FINALED , /
l7L
INSPECTOR
Z � 0
0
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECFI LAICAL 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
y BLOCKWALL APPROVALS
Steel
POOLS - SPAS
i Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
_
_
Underground Pibg. Test
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
jf070
;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:
J