0010-095 (RPL)LICENSED CONTRACTOR DECLARATION: .
1. hereby affirm under penalty of perjury that 1 am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division'3'of.the Business and
Profe'ssfonals Code, and my Lice"n,se is in full force and effect.
LicenseYt I Lic. Class Exp. Date
1 1613 t i.5
DatE' t ice— Signature of Contractor--• L • _V �.t!
Vv
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).
(-) 1, as owner of the propevt , am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O '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:
Cartier Policy No.
(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 .l should become
subjecIsa
e workers' compensatjon Rrovisions ofkelion 3700 of'the Labor
Code;f rthwith comply withs2��rovisi6ns."
Die: Applicant
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 -M6
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 per son%t s
._whose request and for whose benefit work is performed under or pursuan6o' I
any permit issued as a result of this applicaton agrees to, &.shall, indemnify N
& 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 foY inspect' ornpurposes...^' £
ES gnature (Owner/Agent)-�--f4 ^'t h 4 r Date p .
1v \J hN f :
BUILDING PERMIT •- PERMIT#
DATE VALUATION LOT10 V TRACT
!
JOB SITE a
APN
ADDRESS
47-410 V1A)rX,.0REN-Cr9
OWNER
CONTRACTOR/ / EN INFER
C, ,t^2 . h ds C It +i Y
Heb:. HAWY10:9 tiba VAC''.A3'I:L"N :Pe,3f?�. S -
3'Y4ROL 1,7T 9-1. 04 66
95212,DO.1bPLDSONRl>,
"4"'�7ia L.A `3 lL50
L�7f_'61ILM, A1.LEY' 92356
CY60)2hS8-0045 aft14 4335,-
.335,.USE
USEOF PERMIT
-`t tt"1 • AND/OR AM.%
'POOL &:SPAOP•Y,3.Y.B:•7.�$247`�`r�l�A���'a��`"� BE M PLAC➢:,F T !.
P,ttiE-Pl. ZTER INSIPECTIOR.POOL XQUIPMEN T !E:i1O i0OUR its NOT
RICI,�'t.Tt7VO 111E °f'f IS jPl<'''R)MIl'. (LOT 114 NFW MODEL)
POOL 101'f?aO.R 0 1!.000too La
°
9" Ity
PLAN C1'ECKFF19 $10&30
C014S •lt.[lE:TMFEE 101-000-418-000 lfa,tii!
Af1ECliMUCAL 'Y1' E -- POO L ' 101-000-421-000 $24.00
�LPfr>'"t'l�tB4',..P+.i!dlrww�-_.ia0�.1Z...�G1�•E�l�'1��'b.,�0-�f4�"] ;�4�,Oi3
PLUMOiRO ?``FX — POOL 101 X000.41 5�"'01010 1;t`i<Sifs
P1 D
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OCT
LAOUNT
RECEIPT
DATEBY
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/,Kip
D E N ED
INSPECTOR
(<11
.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE'
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Siab 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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Footings
Electric Bond
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
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping.
Gas Test
Appliances
Final
COMMENTS:
l
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
1
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)