0004-030 (RPL)~' LICENSED CONTRACTOR DECLARATION
I here y'a rm rider penalty of perjury that I am licensed under provisions of
Chapter 9 (commer�ikig with Sectioni)7000) of Division 3 of the Business and
Professionais Code, and my License is in full force and effect.
License # Lic. Class Exp.. Date
35,167 C53 i 01/31/2(
D e �/✓�� Signature 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 structu4is 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 islissued. `
( )tel -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:
CarrierSTATE MD - Policy No. 229.00-0019339
• I
(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 thq/workers' compensation)provisons of Section 3700 of the Labor
Code, t'shalr forthwith comply with those provisions.
Datec'I/ Applicant!'
`'Warning: Failure to secure Work � 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 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, 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 l 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 inspectiojpurpose
Signignature (Owner/Agent) =f'� Date
BUILDING PERMIT - PERMIT# _
DATE j VALUATION LOT 00"-030 TRACT
JOB SITE ( Iv
APN
ADDRESS
78•-M VM kLOW.NGE
OWNER
CONTRACTOR/DESIGNER/ENGINEER
r
CMAUAY & COWAN Y
HAL NAWTON dba VAc MOOT POOLS
17480 Z 17TH 3T. ##106
9522 DON,AaLDS01T RA
^'
TUIMIN• CA 92780
LUCHMEVALLE7CA
'Y
9233
—n
CBI.:## x$35
f
USE OF PERMIT Jt
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POOL&SPA ONLY-ALARMSMAR.RIERS S14ALL BE fN PLACE AT PRS'Ml
_
K AMM 113 SP1! MON ONLY
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P/OOLL DIOR SPA 14,500,00 LS f
U UI
ESTIMATE- COQ.' OF CONb'MUC:I;1:ON
I4=.00
'PXR lTrRE 6IJi1d &AARP
PLAN CHECK FEE 101-000439-318 t $103.30
CONSTRUCTION FEE 101-000-418-000 $163.00
_
MECHANICAL FEE -- POOL, 101.000--421.-000 $2.4,00
ELECTRICAL. FEE •a POOL. 101-000-420-000 $43.00
PLUMS M0 FE -• POOL 101.-000.419.000 $27.00
SUB -TOTAL CONS TRUMION AND PLAN C K
$363.30
LUSS PRE-pP113 FEEZ
$0.00
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RECEIPT
DATEJqIT
FINAD
INSPECTOR
rt
T
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
sat 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
1000,
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
Ov
-
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)
COMMENTS: