0102-038 (RPL)_ f
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that 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 # Lic. Class Exp. Date
WINWIN/fir. ". f
Date Signature of Contracto ,. +
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 intendedor 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).
( ) 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 oYhe Labor Code, for the
performance of the work for which this permit is issued.
SFN) 'I have and will maintain workers' compensation insurance, as required by
Ction 3700 of the Labor Code, for the perfprmance of the work for which this
permit is issued. My workers' compensation finsurance carrier & policy no. are:
Carrier Policy No.
STATE MUD
(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 t e Labor
Code, I shall forthwith comply with th6b provision
Date: Applicant °1.
Warning: Failure to secure Workers' Compens ion coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit .subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under'or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees'li
2. Any permit issued as a result of this application becomes null and void iP
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property foP 1 spection purposes.
n
Signature (Owner/Agent) we cr ' o. Dater
r i
r r a .. x w x •s Y
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0002,039 TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CAPITAL PAM CHONOMWCC
CATIMM&POOLS A, PAL'
4100 .14W.. MyITMR BLVI') #200
74425 CONI DRIVE,. 0A.
+3;IN"AffilG rl,:OLTAC.E=T C;ea :92660
PAbAddl'�i;�.&'��RIT CA 92260
(J60" 34-0-'9000 CM -0 5386
USE OF PERMIT
IRA-
POO3p1drR:.�lgl�q�F..A]r~�I�J.tilkni�2pp"�&�R1��t`r.$kaL-1.k�d7�a°yo.�Rt1AttAtp~p'ir:�h�A7"i{����i,3�.'ap,��y
peOO.tggL'+,73Pn:�Y',
JPLA )'�.p;R /. t.WCT%'�A:CTB 101-1,7. 006 i QUIP!.Y.a.YNT .E;cE�,:Mk+o) RF, WNW ,t i �V1+�8ef.77.f: D
A4171-119 PERMIT
P70L:1, A14DIOR SPA MOM Lr3
s. IMIM TED WST OF 1COM'&` .I IC11190 t
;�>xp"wr in m sum",uty .
PIAN 101uP'rtr0439-3k8 $I:qg l0
r:.'Oi4STRUC`1'a(Mlt E 101-0,00-418440
ro' c� 1? 'a 00 11 000 7rl,tta
�n�uf3.iLX�r, w b OTS
E r.Cr°TRXIAL ..P L. 101-000-4 26000 $45.00
KlNV'OTC 7%8 _ POO* Ns, 101-000-419-000 $27.00
N
MAR 12 2001
LA V.0
UP= FTM -PAM FEW
MOO
r
_
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
Exh2ust 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
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
6—1
'
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)