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0009-095 (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 ,Rro414e and my License is in full force and effect. License # ` Lic. Class .. Exp. Date 1;5612 '' ! �'3ti'' :i l;ii31/'1C Date ' 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: ;' ( ) .1, as owner of the property, ormy 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 .1 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. - (;f,) 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 nb. are: CarrierSTAT; FUNC Policy No. ,�0•©0061 3-00 (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 the workers' compensation provisions of Section 3700 of the Labor Code, I.shall forthwith comply with those provisions. Date: , Applicant f -:a- 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. 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• employees. 2. Any permitissued 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 suject 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 PERMIT# fi DATEj/VALUATION LOT ^� TRACT JOB SITE APN ADDRESS 48-594 VISTA PALONMO o OWNER CONTRACTOR/DESIGNER/EN INEER IrD Oso UER T' l i EADPloWN : ' CAT<Qy0RNIA POOLS 9PAS q PO BOX 1716 74-723 JONI DRIVI; #A LAgfYMTA. CA 92253 PA%.A.dT)MEW CA 92260 ' 1 - USE OF PERMIT'"''' POOL "D/OR SPA DODOS).! /..BrIQ-ALARMS'tBARP,IEPS SHALL BE IN PLACE P.T�PU PLASTER INSPEW'TION,POOL EQUIPMENT ENCLOSURE til Nb T INCLUDED IN THIS PERMIT POOL AND/OR SPA I3�,^s0o,tt0 I,S WD"IND LOST OF CONSMSCTION P.ERW FEE SUN WVIARY PLAN CHECK F19 .101-000-439-318 CONSTRUCTIONFEE 101-000-4418-000 Adi!.CIIANICA1, FEE •= POOL 101-000-421-000 324.00 ELIXTRICAL. PSE - POOL 101.000-420.000 $45.00 PLUMBING FEE , POOI. 101.000.419.000 $27,00 MTAL CONO'LM.ii'MON.AZM PLW f'.,T'. f''X $378.15 IMS PRE-PA.m FEE 3 $0.00 TMAL I' d:1*! F ` S DUE.NOW 87€1,1,.4 - RECEIPT DATE BY "; ;r �' BATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS lacks Underground Ducts FFons &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 Footings Electric Bond Main Drain Approval to Cover Bond Beam Equipment Location Underground Electric Final PLUMBING APPROVALS Underground Plbg. Test Gas Piping 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 — �O 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.1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) W