9905-074 (RPL)LICENSED CONTRACTOR DECLARATIONhereby affirm under penalty of perjury that I amlicensed under provisions,,ofChapter-9 (comm . encing With Se"ct-ion'7000) of Div'is*ioh*3'6f the Business andProfqssion�als Code, and my License is in full force� and effect./eOWNERmBUILDER DECLARATION[,hereiby affirm. under penalty of perjury that l.am.exempt from the Contractor!sLicense Law for the follo.%�ing reason'.as.'owher of the property, or my employees with wages as'theirc6mpensation,.will dofthe work, and the structure is not intended or offered f6rsale ec.. �044, Business & Professionals Code).Contractors toconstruct the.project (Sec. 7044, Business & ProfessionalsSection B&P.C. for this reasonSignatureDate of. OwnerWORKER'S COMPENSATION DECLARATIONI hbreby affirm under penalty of perjury one of the following* d661araitio�*�Ompensatio , n, as provided' for by . Section . 3700 of. the Labor Code, for the�p /e;rf of the work- for which this permit is issued.rk4rs' compensation 'insurance, asrequired by1�1h-ave and will maintain wobon 3700 'of 'the Labor Code, for the peff&Mance of the work for whi�h thispermiVis issued. My Workers' compensation insurance carrier & policy no. are:Carrier Policy No.OTAW FUN(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,n'ot employ -any p, erson in any manner so as to become subject to thewo . rk . ers compehsatio n laws of California, and agree that if I should become�6bject'6 the workers' - 6ompengation provisions of Section 3700 of the'LabdrQ6de; I -shall io"rthwith Comply with those provisions.Date: ApplicantWarning: Failure,to secure Workers' Compensation coverage is unlawful andsh�ll`§ubjelct an em�lo�e( to Criminal penalties and 6ivil iines up to.$1 00,000, inaddition to the cost of coml56nsation, damages as provided for in Section 3706of t�b Labor Code, interest and attorney's fees.. 'IMPORTANT: Application is her6by made t6 the'Director of Building and Safety1- 11. EacKperson�upqn whose behalf this application is made & each person atwhose re , quest and for whose benefit work is performed under or.pursuant.toa - ny . permit issued as I a.result.of this applicatonagrees,to, & shall, indemnify& hold harmless.,th6 Cit� of La Quinta, its officers, agents and employees.Any-p6irmit �issued as a result of this application becomes null and void ifwork , is.not com&hceib Within. 180'days from date, of -issuance bf.such134 ermit,� or� cessation of work'idir. 180 days will subje6t permit to can6ellation..6&rtify-that I have read this application and state that the above information isoirrect' I agree to'complywith-all City, and State laws relating to the building46n§tiuct . ion, and -hereby'authorize,-�epr,espntgtiv6s of this City to enter upon'the -above- mentioned brop�rty for inspection purposes.
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 7-9-050 VLA COKUk
OWNER
CONTRACTOR DESIGNER ENGINEER
PO BOX 1716
74-725 JONI DRIVE, #A
USE OF PERMIT
P001. AM101Z 0A,
PERMIT FEM,0 SUMMARY
COINSIRMT.1014 RES 10.1-
MECHANICALI-T-h - I I -W
T-400042
ELECTRICALf',06- POOL _4-000-42040 i
PLUMIUNG FEE- P00111 01-000-419-000 WX
INSPECTION RECORD 14
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FlAures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: