0101-264 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapteg,,(commencing with Section 7000) of Division 3 of the Business and
P` fess) als Code, and my License is in full force and effect.
ICen9 Lic. Class Exp. Date
614611
Date f Zma,��LOJSignature of Contractor
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 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).
( ) 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 workers' compensation insurance carrier & policy no. are:
Carrier ypn p yp ypryy�C� �{ Policy No.
_9S'd�Ridid'LL9S6✓IYW�pt,�I.EY.r rNY''Op�id l7+�'i�y.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not emplojany person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply'wi$iahose provisions. 44
Date: �t Applicant`s+_ `I -
Warning Failure to secure Workers' Comre cation coverage Is unl wful 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 37
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 O2 his
application.
1. Each person upon whose behalf this application is made & ea r&V .
whose request and for whose benefit work is performed under orr rsuant 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 representatives of this City to enter upon
the above-mentioned property for inspection purposes
/Signature (Owner/Agent)
} w
1.
BUILDING PERMIT PERMIT#
DATE / VALUATION LOT 01f).1-26.4 TRACT
JOB SITE
APN
ADDRESS
8 1-070 ENDS WAY
OWNER
t
CONTRACTOR/DESIGNER/EN (NEER
CORPORALS PLAZA #245'
:x=110- Box 1141
1NWWPMr MACH CA 92660
LA QUMV1. CA 92!W
CwX
USE OF PERMIT
Pt)C?1...131 YUR. SPA.
F�t,;aOf • & VA 4 1+83.,Y -A1 M3/&3,F►R3URR3 SHALI, SX iN PLACE AT PRZ
IA.07'Kit INSPEC,`i:E01`i':P001, EQUIPMEWT ;NCLOS M 1:9 NOT MCL,UDED
IN THIS Pti:3E&fE T
POOL ANDIOR. SPA Ls
tn�6K:6{��((,,ff��/p� y�. ,S,�e,�p VV//����tt�� / qp /�7/y1`YR± e��yp� y�Y p
l/ wt7:IL91.�AxEr.!`�A '\.�09T 0 4.. Ci.1111XtI.IL6'L.TL.IIEOAN
y�yf�,1�S6
x�yy,, pp�� ��yy•yvpp yy.,,�y ,,��qq �p Q.
:ir:EYS�:i1A�.P'�EYE WOMMA T..3
PLAN CHECK t��1E 101-000-439-318 $41MID
M. NSTRUCTION MY. 101 -000-4 t�c�i;;a �taa.fa�
101-000.420-000
LUMIN190 FEE P006 101-000-419,-000 MIA
L0 ,.
SUO-TMAL CONYUTRUC`'17011 AND PLAN CHECK
LE50 PRE4 'AID _M=
x;0.00
' TCYJ'IAL 1YX'kb FII ELM,811•.A'4IE X0W
RECEIPT
DTE I
BY=
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION 7-D
ATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Backs
Set
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 Wali Insulation
Condensate Lines
Party Wail 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
Gas Test
_
2 e
- --
PLUMBING APPROVALS
✓
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
COMMENTS:
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)