9902-094 (RPL)O
a`i
LICENSEDCONTRACTOR DECLARATION
Fhereby �i
_ffirmdunder penalty of perjury that.1 am licensed under provisions of
ChaptbK (corn . m ., e ncing . with Section 7000) of Division 3 of the Business and
P4fefkisionaliCocle, and riIj License is'in full force and effect.
License # f Lic. Class Exp. Pate
5 OKA*.
loate* qgn,ature3of Contractor__,�.X
. OWNER -BUILDER DECLARATION.
1. hpreby affirm,under'p'ehalty of perjury that 1, am exempt from the Contractor's
License La W' for the following reason:
-1, as 6w -of the property, or my employees with wages as their sole
cbrnpen sation, will do the work; and the structure is not intended or offered for
sale (Sec, 7044, Qusiness & Ptofessionals Code).
1, as owner of. theproperty, am exclusively contracting with licensed
contractors to construct the .p.roject (Sec, 7044, Business & Professionals
Code).
I am.,exempt under Section, B&P.C. for this:reason
Date.- Sianature of Owner
WORKER'S COMPENSATION DECLARATION'`
I hereby'
ieby' affirm under
n der penalty of perjury one of the following declarations:
(._.)�'4have 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
p6rforlmanc6 of the work for which this permit is issued.
(0-I'l have and will -maintain workers' compensation insurance, as required by
Section 3700 of the' Labor Code, for the performan66 of the work for which
ich this
permit is1ssued.,My workers' . comp6nsation insurance carrier & policy no. are:
Policy No.
UNY I
(rhis section need not be completed if the permit Valuation is for $100.00 of less).
I certify that in -the performance of the work for which this permit is issued,
I"Shall not employ any - person on in any . m . anner so as to become,subject t6the
woiker��: ompensation laws of California, and agree that if I should become
§ubi.pct to the workers' compensationprovisio
of F�ctioq,3700 of the Labor
1. rth i comply !h
Co , I shall'I h i 'e. p s//J._
Code;
JDate:
Applicant- -
Warning:.Failure to secure Work-eVCompensation coverage is unlawful *and
shall Subject ah'erriployer to criminal penalties and civil fines up to $100,000, In
addition to the'co§t of compensaticin,, damages as provided, for in Section 3706
of thbiabor Code',7inte'rest-and attorney's fees..
IMPORTANT.Apolication is hereby made to the Director of Building and Safety
for. ai . permit, subject to th6 conditions and 'restrictions set forth on his
I.'Eac.h persbn upon who,s; b6half this application is made.& each pqrsonat
whose request arid for.Whose benefit work is performed under or pursuant to
permit. issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the I City of La Quinta,its-officers, agents and employees.
`.Y,,My permit issued as a result of this. application becomes null and void if
work is not commenced within 180 days from date of issuance,,of such
1permn;..or.cessation'of 'work for 180 days will subject permit to cancellation.
I Certify that
hat I have read this application and state that the above information is
correct:.) I agree. to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter.upon
the above-mentioned property for ins p quon purposes.
.Signature (Owner/Agent Date2l
PERMIT BUILDING PERMIT P!�,902_094
DATE 2/171`99 VALUATION &J3. 4100.4K) LOT. TRACT
JOB SITE.
,1VOCoC,
ADDRESS '474;95 VIA F 10
PNN
OWNER
CONTRACTOR ENGINEE• R
CANAIJAY& CCAW.VANY
rg+Dp1E4yS1?IG°uN?E`R
1570 BROOKHOUGWIDRIVE, SUITF 208
9522 DON,ALDSON-ROAD
SANT .A ANA. CA 92705
LUCERNE VALLEY CA W2,3M
(,-700Y-249-6045 `C 14 4335-
F
USE OF PERMIT
POOL KNDA)UPA
FJ C �G_ W
LOCA, &SPA ONLY- MLA
PRR-PLAYFER INS
FOO L A' NEXCIR SPA Vv, 4 0 0, 0 0
N
it A#%$% on
P XR D A T F C. C 5, U'R It, F A RRY
PLANI CHLCKM 1.01-M-439-318
FEE— 10 -14 -0 -418 -OW vnoo
.h-:IE,,.C11NNRCAL FM -POOL. t0l'401)Aillloo .$24.00
L POOL "101 -WO -42"00
ELECM"YCA �ME
PLUMBING FTE –.K -)OL 101-000-41.9-000 $.27.00
CC)NSTRUCTIObi AND PLAN rj-l'rrl�
,,?-, .;4 �1,
LESS PRE-10AAD rFEES
TM*
WilALP 0, RAIFT FENC 8 IYWYE, NOW
5348.4$
RECEIPT.
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
J 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
all -
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
11 L
Gas Test
Appliances
Final
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.t.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: