0311-106 (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
6906.5 Iss HIC A 06/10/2(
Date �� �' 3Signature of Contractor�'�—�—. •-
/ OWNER -BUILDER DEC ARATION
"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 STATE FUND Policy'No. 1523906-02
(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 Calif?rnia, and agree that if I should become
subject to the workers' compensati?A provisions of Section 3700 of the Labor
Code, I shall forthwith comply with t ose%ovigions.
Dafte: . 17/I M. Applicant�f t •ale�r
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 perform`e8'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 i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter upo
the above-mentioned property r Innspecttii n'purposes.
Signature (Owner,Agent) y� �" �— Date 1 �� •a ,
rc. - . .
BUILDING PERMIT ' BUILDING
DATE VALUATION. LOT TRACT
55
JOB SITE�` a r
APN
ADDRESS :a )41^ �U �A S1.�I yr A, . n•
` '
OWNER
CONTRACTOR /?DESIGEgNr61NE(E}R
pA HOW, cll
y
F0:8Q,X 810.
.1425 E U13l: MTS S)Rf VF .
LA QlrATtA CA., 92253
AHO NIX ,AZ 85011
(6x ,)257=163tz c: 4. 4 p90
USE OF PERMIT
POOL ANIVOR 1V_ A .
POOL, ,PA, 8BQ (V #ZT1,3020 14)..A . Ai.M.S/8ARRPJM3 S,HA.IJ, 891N •
PLACIZ,A AT PI R&PLASTFR TNSP;EC ION, }`:r UIPMM ENCLOSURE 140T
INCLUDED a
POOL AND/O13 SPA fS,t►OO,.d4 LS
i
X". .MAT= COQ tali COMMcrOMON
s�5,t tDUCF1 _
FERN= lMffl 9MMAIRY
t'IiJ!>X CHECK FEE $105,30
CONSTRUCTION FEE 1619-(liliJ-x138-/3II(1 $162.00
MECIMICAL FEE -•. POOL 101--000.421-000. $211.00
F.LZCTRItrAL PRE -- POOL. .101-000-420-000 $45.00 '
;:°S.OM13iRsG FK1:. -. PO0L' 1o1.00(i=419-000 woo `
SUB.T'U o.L CON '8".l'R:QCtION AIM :�1'..RN CHEM
NOV 1 7 2003
CITY OF LA QUINTA /
FINANCE DEPT. ::Y:�;
RECEIPT
DAtT/E y ry
BY zj!DATE
FINALED
INSPECTORry/
:.:
.l+. f"
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
OX 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
` 03
Equipment Location
Underground Electric
3
} Final
Underground Plbg. Test
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,.,-
over..;Sewer
SewerConnection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
F 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:
36.50 TC
1.
-D v S. IS 20 / 34.30 INV.
�.
0'6.1%'' SBp'
---- (, r
19.50' d 36.20
GF = 36.20 -- G I jys'1' `•
-3(3 o -E
J 62 o FF = 37.70 jl i R} J
tiA N I "'� -� 42.84 N, PAD = 37.2
;r. 0 34.83 TF II
5.80 TF FU
3.83 INV @ J
12. 1of I y
J
36.9 ! ! FF = 37.70
0
FL -HP PAD = 37.2
o!-.-..
35.9 50-41(y VA 36.9 ;r
LZ FL—HP S FL-nP
19.50' I A �\\E
36.2-------�
' FL—HP 1 5
3- .9 I
_ 1
-------- 4 36.70
'L -HP —��I-
�: PAD = 36.2 --L-20 TC
_'x.00 35. 3.60 INV.
c
FL—HP) 9.
34.80 TC
.. a U `T
°
34.40 INV. 1 .. a . P�T10
LO
C6 C�l
q/ 5 1 "• i55
----------------
?. TO SF-2AR LOT 53
"'TION ON LOT 53
19
PREPARED UNDER THE DIRECTIOt j OF:
QROf ESS/Cf
ti
No. 20596
Exp. 9-30-01
CIVIL
TF qc W � ,jL����'i,�1' � .' DATE: _1�/� ;..•
uHLCKED By.STA • -r C. MOF>�
R.C.E. 2096 EXP. DATE 9 s -
To
CITY OF LA CSUINTA
BUILDING & SAFETY DEPT:
APPROVED
FOR CONSTRUCTIO
DATE �1--79BY S )�