0210-032 (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 and effect;
License # Lic. Class Exp. Date
690645 B f d C A 06f30 Z(
!Da et PL , - Signature of Contractor'�--
1 4
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). .
( ) 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 S°'I•:dlTF AND Policy No.
(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' compensatiop provisions o�
l Section 3700 of the Labor
Code, I shall forthwith comply with those provisions
Date: ,t .r _ Applicant r° 11'
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. T'
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 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 propertf for ins ection purposes.
/Signature (Owner/Agent)I JOA.,-, * Date /4.1
PERMIT
L
.. BUILDING
_ -PERMIT
DATE VALUATION LOTpPP rrPy�+ wTRACT
.44pdnp
v
JOB SITE�,� ��p� �,�y
ADDRESS 79-63VU VE (.B,.yk ADO
APN
OWNER-
CONTRACTOR/DESIGNER/EN (NEER
R 1 T HOMES LW
Awfx'T.tihk3>T` n,1WC!
PO BOX 810
LA QCliVIA CA 92.253
1410.C.K `' x� 85034
2., 7.1 f 56 (I rl 4990
USE OF PERMIT
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YIiJIJ47.V.aAI d:10 4.no1Sr 0-:01 C.u,IYRRLiCTIOR
PYRWITIC F SUMMA
PLAN CHECK FRE 101-000-435918
CONSTRIXTION PTTIi; 9.�it- l0ti 41�s-JOG $I6d:f16
MECHANICAL FEE -.,'.E00.L 101--000a421,,000 MOD
L:I.,E3`TRIC Ari. RE74.A POOL 'iC34100-420-000 $5.00
1'1. LIMBI' OFFIF,. - Pool,. 101,.000-419.000 S27. OD
hY
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OCT ; Q 2 2002 TOT&,117a1EL^ IM0 Now
OF LA QU Ipi A
CIFINANCE
DEPT.
RECEIPT
DATE
BY ' --- `�
DATE FINALED
INSPE
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
Footings
Main Drain
Bond Beam
Approval to Cover
X$7— f
Equipment Location
Q— 7
Underground Electric7-
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
_
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
s
Shower Pans
O.K. for Finish Plaster
,Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
— D
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:
9
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15 6
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EXIST. 8
N WATERMAI
GF = 34.90
GF 343,){ INSPECTION FE OF $30 CITY OF LA QUINA
WILL BE CH RGED IF THE AP - BUII._DING & SAFETY DEPT.
PLANS AN JOB CARD ARE NOT ON APPROVED
34.6 THE SIT FOR A SCHEDULED FOR C NSTRUCTION
cl Hp INSPECTIO V. <=F
8
VO EXCEPTIONS! DATE) eZ gG�
A. C, pA p 0
M 34.90 FS
34.50 I 1
FL -G8 J I �\
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N J 79-835 VIA PAL MJL /II
33.6 1,
SF �y
o ® FL'GB
J 6 4' I .PAD 35 40
3 34, 6
4.9
FL -HP
41 17 1W J
33.16 FT 33.6 �!
FF = 34.4 0 FL -G8
PAD 33 �o
9 C)
' 1 50, .
PA TIO
64.11 '
J r
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H .�� r PAD = 34.7
7
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