9903-179 (RPL)P.
A
LICENSED CONTRACTOR DECLARATION
l,hereby -affirm under penalty of perjury that I am licensed under provisions of
1r;k6pi6r'6 (ccirnmehcing with Section,7000) of Division i of the Business and
Professionals Code, and: my License is in full force and effect.
License'i-: Lic. Class Exp. Date
Dat'e
Signature of'Contractor-1-
C., t I - 177
OWNER -BUILDER DECLARATION .
hereby affirim under penalty of Oerigy that I'am exempt from the Contractor's
L.icens6: Law for the following. reason:
1;. as owner, of,,the' property, or my employees with wages as their sole
compensation; ,will do the work, and the structure isnot intended or offered for
saI6 (S66. 7044, business & Professionals Code). -
as owner of the property, am. exclusively contracting with licensed
contractors to Construct, the project (Sec.. 7044, Business & Professionals
I ani exempt Linder Section B&P.C. for this reason
Date'. Signature of Owner
'W kER'
OR S COMPENSATION DECLARATION
i.
I " hereby affirm under. penalty - of perjury one of the following declarations:
ave and will maintain a certificate of consent to self -insure for workers'
compensation, as,prcivided'for by Section 3700 of the Labor Code, for -the
performance of the work for which, this permit is issued.
4
1`rkave and
will maintain workers' cornperisation insurance, as required by
Section 3700 ' 0 '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.
�NmicxiT COXII? 1NIS, 1.
(This section need. riot.be completed if the permit valuation is for $100:00 or less).
I(,O -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
w6irkeis' compen - sation laws of California, and agree that if I should become
subject t6't6e workers' compensation provisions of Section 3700 of the.La or
. provisions.
. . - I
Cocl6,', I shall fohhwith'60 1y* it�h thA�se -provisions.
Date P`J t -n 'I w1,071111,Applicant
Warnihg:'.Failure tosecure'% orkers. Compensation coverage is unlawful and
shall subject an'eimpl6yer to criminal penalties and civil fines up to $-1 00,060,'in
addition
tion to the cosi of compensatio , n, damages as'provided for in Section .3706
of the Labor Cod
interest and attorney's fees.
WIIIIOATANT'A6llcatl'o'n 1S Weby made to the Director of Building and Safety
for a permit. subject to the conditions and restrictions set forth on. his
application.'
11.�Eacb.person upon whose behalf this application is made & each person, at
'whose
w 6se-nequest and for whose benefit work is performed under or pursuant to
any, permit.issued as a result of this applicaton agrees to, & shall, indemnify
* i I h6 - Id. harmless the' City. of La Quinta, its officers, agents and employees.
2. Any pe-rmit issued as a result of this application becomes null and void if
is mot commenced within 180,days from date, of issuance of Such
permdor cessation of work for 180 days will subject permit to cancellation.
1,,ce'rfify,th at I have read,this application and state that the above information..is
Correct. I -agree to. comply with all City,`and and State laws relating to the building
' ': ' ' * " '
construction, and hereby authorize representatives of this City to enter upon
the above-mentior4d property fo;r in'spection purposes.
-
Signature (bw'ner/Agent) D to 71
BUILDING PERMIT PERMIT# f9-911113-179
DATE 11171.99 VALUATION $19 . 'fKaimr- LOT I TRACT
•
JOB SITE
APN
ADDRESS
47-5770 VAI A—MOiNfi FTIMSA
OWNER
CONTRACTOR DESIGNER ENGINEER
MON
MIKE FIF, 3N-1CONSTRM
L. POOL COINSTRL .1 (TNJNC.
LAI
CAMUX
7"N'SKYWARD.WAV
78-710 LAPAIAIA DR;, LA 0U[1,4TA,.
'VAJAVT DORM, CA 9T260 -
PALM DESINU CA. 92261
(7,60)360 .M 2 CRI, 181114
-6 .9
USE OF PERMIT
'PQ6L.&NDQR,qPA
POOL /SWk014_L1(, WTILAC� AT PKE_,'LAST FNS
PO.LiVC XOR ZPA .19,0W.00 LS
O
MT) NIATEI) CWT OF MNIVrR1i• C1. TILYN
19,tM.00
IF
PUMN CHECK FEW;. S 128,70
_Pocl� I _000
:1i-1,8cTV,fC.AL FEE $45.00
MUM BINE FEh V001. $27.00
RVIY-T 0, TA 1, CON
$42170
L&SS' PRE-ReUD MEE'S
$42.2.70
k Ae.
,
F
A
RElL;N IN
1BY
DATE FINALED
INSPECTOR
,Nv
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond if
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 77 10,
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)