9904-156 (RPL)f .LICENSED CONTRACTOR DECLARATION N
N' s+j (;;hereby affirm"under penalty"of;perjury that I am licensed under provisions of
Fr I�tapter 9 (commencing with. Section 7000) of Division 3'of the Business and
i tiN w P[ofbssionalS.Code, and my License is in full force and effect.
`License, • Lic: Class Exp. Date
-3116:n1;•�3 di3.l4)1=
L ate * -Signature of Coritracior
DOWNER=BUILDER DECLARATION.
I hereby affirm -under penalty of perjury that I am ex mpt from the Contractor's
License Law for the following reason:
( ) `,I, -•as owner -of the property, of my'employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered 7for
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), - / ..,. .
O I am.exempt.under Section B&P.C. for this reason
Date Signature of Owner,
'ro WORKER'S -,COMPENSATION DECLARATION'
I ,Hereby, affirm under penalty, of perjury one of the. following.declarations:
,.(,)'I have-and'will maintain acertificate of consent to self -insure for workers'
compensatlon,,ds 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 ,Policy No. _
(This section need not be completed if•ti a permit valuation"is for $100:00 or less):
O "I certifyy 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 Iaws.of,California, and agree that if. I, should become
Subject to the workers'.compensation, provisions'of.Section•3700 of the Labor
Code, l shallforthwith`comply with those provisions.,, -
Date ; : ; I r� Applicant .l A r ..vi, ,.
Warning. Failure to secure Workers Comp'ensatlon coverage is unlawful and
'shall subject an employer to criminal penaliies and civil fines up to $100,000; in
addition to the cost of, compensatiori, damages as provided for in Sectiori `3706
6f1he Labor Code,`interest and attorney's fees.'
IMPORTANT, Application is hereby made. to the Director of Building and Safety
for.:ra. permit'subjectAo 'the,', conditions' -and restrictions set forth .on. his
application -
T-1 .Each person upon whose behalf thisapplicationis made &each person at
whose request and for whose benefit work,is;performed under or pursuant to
t any.permit issued'as :a result of this applicaton agrees to, & shall, indemnify
& holdharmless,fhe.City of La Quinta; its officers, agents and employees.
2 Any. permit issued as a: result of this application becomes null and voidl f
work 1S.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 meniioned'property forinspection purposes `
ignature ,(Owner/Agent).7. -f/��' ,) / Date 'r,ft.rl
1 t •
'BUILDING PERMIT PERMIT# i
fit�7i34nSe'
�4'
.DATE VALUATION LOT TRACT w "'
:15.4i�f.44d3 11p' ,
t
g.
JOB SITE 7
ADDRESS 7aY•1�t� i�5.5 VC)
APN _.
OWNER
/ ENGINEER
CONTRACTOR�.�I:/m
yl�i.l .& �»�11,�.i���N V �� �
eDrESIGNER
Ti+r,���l�.,;. 0IN POOLS
1570 i3ROOK!fOLI OW.OlUVE, SUM 208
9522.0(5NALll' 09ROAD
SANTA ANA, , Ok 921105
WC.E,k2NE Vti1.,i:EY G'A 92356
(UO)2.49-64345 030 43 5
USE OF PERMIT
POOL ANO PA,0NLV. AL ARNISrB ARROIS SHflU BE IN Ij1' Ct AT
PRF r.
POOL ANNWO a. WA 15,0t3�1.(3f3 .i's
t;,LAN C.RECiK I[FEB f0?-00fJ-43St-;31F3 $105.30
"Tt2►"t* j'FeP?.. - !W -W!-419:00 - $taa2;lti!
,
��rCHAN'F:-j0)-0W4-,n-0V,0
CAL 1713E -POOL $� 9.�►
r,u, 'fiu A : i!: --• POOL •10$',130 420.000 $45.60
!'F �TAti9lfslcf:4r`. :-- i3CiF. 191-A'3t90��4i.5,-(3190 '$27.00
t`.3'1.Od r11,, C:(,P`JTrI tC'tC1P+F,t1,N1'f 3'.I.,A;N C3.4}a�°3363,3n
LA:;�9 BLitt?"' IIID F. PHES
'$0.00
TCYCIA.11 11TVIKES4 Our, NOW'
$363,30
�R CE` \
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
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
y•
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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: