0007-265 (RPL)D CONTRACTOR DECLARATION
I hereby affirm' salty of perjury that I am licensed under provisions of
Chapter.9 (com ith Section 7000) of Division 3 of the Business and
Professionals C y License is in full force and effect.
License # Lic. Class Exp. Date
65€12€ 053 tit 31/fit
�? r" 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:
( ) 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).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
t 1 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:
CarrierSTATE I+` ND Policy No. 046-00-00A61103.00 .
(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 s�hall,forthwith comply with those provisions. sy
;Date: {' Applicant
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 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 inspection purposes.
r
Signature (Owner/Agent)''>7 Date
6d" BUILDING PERMIT PERMIT#
DATE VALUATION LOT "7_266 TRACT
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JOB SITE
ADDRESS sm lrm•YwjlANA
APN
_
OWNER
CONTRACTOR/DESIGNER/EN (NEER
TO DESMT DEVELOPMENT
CA;..XF0RWIA;POC3U & SPAS
PO BOX 1716
4.7'25 JOXI3 RIVE, #A'
1A QUCia'TA. CA 92253
MM T)F,Sl<:R`t' CA 42260
(760)340-9000 CBI.4 355
USE OF PERMIT
P001, AMIOR SPA.
Poot, a si,)A O:d y.A.LAwst1imwrein Sl-1Aa.:1; i4y, iN in.Acz A l° PRE
PLASTER 3NSIPF,C:fiiOX]POOL, RQUiPM13,11T CL !; URE 18 NOT TNCLLUDED
11,11 THIS PF"IT
POO1,,81NDJOI3 SPA LS
9571MIYD COST OF CQNS1'RU(71' ON
151000.00
PEM -If PRE subsWARY
PIAN CHECK 101-000439-3113 sl os.3q
=NSTitUCTIO'Ai FEZ 101--000-4384000
P+ ECHMICAL PUr -- POOL 101.0001,421 4100 $14,00'
ELECTIZ1CAL 27l:N — POOL 101,000-420-000,a
i'il-000-419x000 � ; ,
IDPE.UMBINGRE•-'POOL
AUG 0 2
2000
9.,
QUINT.
SUB-T%DTAL CON•SI'.RIxC;� 09 A1,W PL A14 C1:• tM,
t 1,903 PRE -PAM 7-7m
y WDAL T 'T F°l-S M ?`TOW
$XNV
RECEIPT
DATE
1 BY /
DATE INAL
INSPECTOR
f;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
' f s 8 Footings
Ducts
jade
Return Air
1jeck
Combustion Air
Exhaust Fans
..r, 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
V
Set Backs
Electric Bond
ce 671
Footings
Main Drain
-
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
_
PLUMBING APPROVALS
Gas Test
Electric Final
LAL
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
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: