0402-376 (RPL)LICENSED CONTRACTOR DECLARATION
Cn I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
cel W Professionals Code, and my License is in full force and effect.
O = M License # Lic. Class Exp. Date
r—du7
r- w It f 5S 2$ C53TRIC' fi / k/3 iAY
t/ / i t �
o OZ � Date ' ' / Signature of Contractor ' ��
CD _
J U CC:) o OWNER -BUILDER DECLARATION
W w I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a. License Law for the following reason:
Z ( ) 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C'') () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
O N
rn
Q WORKER'S COMPENSATION DECLARATION
p CC I hereby affirm under penalty of perjury one of the following declarations:
Lo FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X LU �: compensation, as provided for by Section 3700 of the Labor Code, for the
0O � Q performance of the work for which this permit is issued.
Q C0 k)—I have and will maintain workers' compensation insurance, as required by
O Q Section 3700 of the Labor Code, for the performance of the work for which this
LO
Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
v ? Carrier :'TATA �C>MP><1N3A7I Policy No. 046-6113 2i'0�#
00
�0
J (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
3 subject to the workers' compensation provisions of Section 3.700 of the Labor
Code, bsh_all fo thw ith comply with thos rprovisions.
Date: Applicant—
"?—��•'
Warning: Failure to secure Workers' Compensation overage 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 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 in'specti n purposes.
Signature (Owner/Agent) %+�+� Date W f
9
BUILMNG PERMIT PERMIT#
DATE - VALUATION LOT 0402-37£ TRACT
M. lbLiltl.v�f ils.�
JOB SITE
APN
ADDRESS 8 .5_•1 V.U11 AE.,INA
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TOLL BR01HIM J21C
CALD ORNiA .POOLS LUSPAS CMI) MAN CO-'
73-121 FMT) WARING M OD
86-100 AVVII�Wt 54
I>.ALUDESMT CA 922£0
COAC.tI1I[.A. SCA 92236
(760)398-9222 BL# 00355
USE OF PERMIT
POOLAFlLYOI? SPA
POOIJ PA, 880(ANSI Y21.58-1995), F IREPIT(49,6A:O.AL) 25 L.P.
4- BLOCK WAU, CITY STANDARD, 6ALY. 4' WROt1Cl1#7' IRON FENCE
AL&PM3%8A2R1Z1t.9 TO BE 114 PI.ACZ A'r PRE.PLMSTL1t INSPECT1011'.
S FT, WOOD FENCE 00.00 LF
d FT. WALL i5.013 LF
POOL All DfOR EPA 191141,00 LS
Z(;H1111;'1<ATED COST OEC (;O1`iSF223.TMON
291000160
PERWr YEE fii3MM&RY
PLAN C}iKK M3 101.000-439.316 S12218i
CO'N'STRUCTION FF T 1:01-000-419-000 $189.410
MECHAVIC.A L .FEE •- POOL 101.000.421.000 3X00
ZLEC..TI'LICAL Fitz >- Pool, 101-000.420-000 $45.00
PLiY14i1I1x1C1 FEE -- POOL 101.000.1119-000 Sxi.a�
Di i -A
MAR 0 5 2094
A
CITY OF LA OLIINTA
FlN%ANGh IDEP1.
frLI3- OTAL Cf7MMCIt'',TlrJN AND MM CITECK
$407.85
L:ES3 PRE -PA' D f,7 , 9
$0.00
TOTAL I']J:d M. IME HOW
UOMS
V
RECEIPT
DATE �!
BY"
ED
INS E
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
POOLS - SPAS
steel
Set Backs
Electric Bond
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
Gas Piping
Gas Test
Z,
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
V.
COMMENTS: