0102-199 (RPL)LICENSED CONTRACTOR DECLARATION.
I hereby affirm under penalty of perjury that I am licensed under provisions of.
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force antl effect.
License # Lic. Class _ •- -^E�Cp Date
/bateSignature of Contractor
41.1OWNER-BUILDER DECLAf ATION
•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). , '
( ),-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 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.
STATR FUND
(This section need not be completed if the permit valuation is for $100.00 or less).
.( ) I certify that in the'performarice of the work for which t�1i,'s.Permit is issued,
I shall not employ any person in any mafnn r„so-aglo become subject to the
workers'• compensation laws of California and agree that if I should become
sybject to tlAe orkers' cornweatlon revisions of Section 3700 of the Labor
'Code, I» o ! fo hwith comply with-tho ee. r, v'sions. t
f Applicant ti,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety".,
for a permit subject to the conditions and restrictions set forth on his
application. ayt
1. Each person upon whose behalf this -application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and" emploeyees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for,180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with Bill City And -State laws relating to the building
construction, and hereby authpufelepr9sentatives of this City to enter upon
the above mentioned proper ,f6"rspection purposes.
Signature (Owner/Agent) �'Date
(
BUILDING PERMIT PERMIT#
DATE p� VALUATION LOT�.�9,C) TRACT
tnavana
JOB SITE
APN
ADDRESS
4.8-494 STA, PA.T_,O1WW0
OWNER
CONTRACTOR/DESIGNER/ENGINEER
WM. HOLTbAND
r,�3:+OX P00T. 3) CC7MSTRUCT.1014
46-494V WMAP.FLf?WWO
5: 300AMWA1;. T%3+7
CA, 92253
TA QUIt4TA CA 92253
(,160)5644655 Mu. 211391
USE OF PERMIT
:p�C'16.Dgn.L.fi,�3"��ppfCyS�7RIVAq��[
�y gW� t �r qy �g J )�y�(Juppy}� �pC, { *,1q p �}p/
f �0i,i 4�IA'b Y3i L{.fi4t9J.i'MO�J4➢�l�g b�AV 7Af �CLJ.�[191101 s71.1.1J•1Yi.64 I$�'.C4� n4A",CJ.�Jl.+:l,�i:u
[ P1, _A,( 1,.RLW PIAff1;R 3N'SPWTIOAPOOL. W-011l'.f9%i'E?;h T RNC"W,9URT
IF,'NO'li 1,01r.3XID910114 HIS PrIRMIT
4"%dVir. ,C's.e9l.+11.1116. IC :R'0 �rpi�f��°•aN LS
sr,M 'T`: COST 03+' C0N'S'.3a U: ,110W
; y;'I W 6, P
PIAN C:I MC"FCTRE 101 -000,4, 39. 18 SI 03,80
COrl VIZUCTICIN FRE '101-000-418-000 U52.00
14 iUCg's`ANICA1, FE, P. :- POOL '101 -000-421.000 $24,09
Z.ef3i�� �d�" Yfi L ' 101.000-439.000 3321,00
�.
IOU
MAR 0.6 200.1
Y U kLA �a E
1:
3��4 'A' C``CI'."i'.CiC;'Tt0.p1' ftit1T ✓ �".)5�
I.SG
LEE* FRE -PAID FM43
$0.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I 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
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
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
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:
m
INSPECTION.
22'-7"02 _„ 'NO EXCEPTIONS!
000 C a E x ��
AM "IM -16M
Holland 'Home'El.
48494 Vista
. 'Palomf no
'Rancho L®; Quenta
Ll
Con-truction,-
00
O �,
Pools Spas Fountains
G MW
_
760 564-3655
❑❑ )
,, Lic. 658996
ice}
v.. y
•
• .q
�7
t• •
M
f•
J
r„
A"
i-
a `
v
+
Yh
p
+Y .
• a:f
i
a•t}
a. 1
111
�� a , � °°
�
� j 4 . 'i a
/L�'�♦a�f
tr'td'vp��yy,
CD
oz
CIO
rT
s