0009-236 (RPL)LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
apter 9,(comme'ncing with Section 7006) of Division Yof the Business and
ionals Code, and my License is in full force and effect.
ense # Lic. Class Exp. Date .
� ttrr��yy� �•ee�± tt.,} 44. yyfa
Date 4`' ,F. 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 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).
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION .
1' 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.
(This section need not be completed,if the permit valuation is for $100.00.orless).,
O I certify that in the performance of the work for which this permit-is;issued,
I shall not employ Iany person in any manner so as to become subject to the
workers' compensation, laws of California, and agree that; if Lshould become
subject to:the workers' compensation provisions of•Sectlon"3700'of the :Labor
Code, I shall forthwith comply with those provisions.
Date : Applicants
Warning: Failure to secure Workers' Compensation coverage. is unlawful and
shall- subject an employer to criminal penalties. and civil fines up td $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
" of the Labor Code, interest and atto, mey'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 applicator agrees to, &'shall, indemnify
& 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 for inspection purposes.
`Signature (Owner/Agent) Date–/ • �:
BUILDING PERMIT ' PERMTN
VALUATION
DATE�f,�
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OWNER
CONTRACTOR / DESIGNER / EN (NEER
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CALEORNIAMPOOLS � �lyQ►�'
48-5$7 VIN'TAMC d} .190
74-725 x0NIMM, 0A
LA; QI,iI-TrA. +~'A 92233
TPAI.1' . DES Xa CA-' -9figo
�7 J t)3�1C��0000 .� 37 355
USE OF PERMIT
fu00I.SSPAIMATEA"IAZ'URP, ONLY•ALA,fxA kiaM1.RRIERS SEXA4 HE IN PIA -CF, .
Nf PRE FUER,INSP CTION. t. 1Uk`P .[?NT .M L41011im 18 Not
INCL 111), )TAE THIS PERMIT
Y1006ANDJOR SPA iklvo.00. LS
XSTMA'h'K C M.R' 0F 00149 ti.. I1MOdN
,7IS97Jf 31
ppm r F, ER RIVD&ARY
PL -AN 0-MIX PER.` - 101-000.4 9.31 W� $117.00
C".fV—ViltYlt;TIONFEE. ': 101.000-418.000 $I80X0
Mir-, t"W�AICA1, EZ ... POOL 1 01,,W-0-421 -0W _ WIN
EL C9'xt;ll(IA$. FY:F C•CCC:?L: , 161 -0pa-420--mv t .ati
3PuNi INO ;v+1I'... Pool.. 101-000-419-000 0.419a000 $27.00
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V95,00
J LEI15S FIRE-PAU) .�+'.I
S0.03
05
RECEIPT
DATE
�BY'�w M �� u °
DATE FINALED
INSPECTOR
f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
fi- 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
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric. Bond
Footings
-Main Drain
_
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
_ ,atlz
Final
Gas Piping
Q
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
_
Water Piping r
Plumbing Final
-
Plumbing Top Out
Equipment Enclosure
-
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
— --
-
Final/—
COMMENTS:
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)