0012-040 (RPL)( LICENSED CONTRACTOR DECLARATION.
I hereby, . ffirm underpenalty of perjury that I am licensed under provisions of
I(Chapid';9 (commencing with Section 7000) of'Division 3, of the Business and
'rofessionals Code_ , and my License is in full force and effect. '
License'# • Lic. Class Exp. Date
Date
';3 -7 -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 in_tended•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).
O I am,exemt and r Section F` B&P.C. for this -reason - ^ °
Date Signature' of Owner'-.
WORKER'.S COMPENSATION DECLARATION'. r
I hereby affirm, under. penalty of perjury; one" of the •following declarations`'
O I Have and Will maintain a•oertificate of,&.on' ent 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. 't
(') rl have and will'maintain workers. compensation Insurance as required by
Section 3700 ;of'the' Labor. Code,"for the,perforriiance of;the;work for Which this
permit is'issued.'My workers' compensation insurance carrier &policy no are:
CartierPolicy No "
STATEB�9=tii� 011I4�I 2
.(This section need notbe�completed if the permit valuatlon'is for $100.00 or less)
(' ), I certify,that in the."performance of. the work for which this permit is issued;
41 shall'not employ any person"iri any manner so;as.to become subject to the
workers' compensation laws ofCalrfornia;-and and thatlf I should become
subject to the tlworkers' compensation provisions of:Section,,3700 of the Labor'
Code; I -shall forthwitcomply with those`provrslons..
Date( Applicant t `�
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject anemployer to criminal penalties and'cMl fines up to $100 000 yin
addition to the.costof compensation, damages •as provided for in -Section 3706
of the -Labor Code Inter@st'and attorney's fees
IMPORTANT Application is hereby made to the Director bf Bwlding:and Safety
for, a permit subject,• to -the •conditions -and restrictions set --forth on his
application;t"
1. Each -person,upon whose behalf this.applicati6n 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 applicator 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 become's•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 7City to, enter upon
the above-mentioned'property fdrinspection.purposes
1
Signature (Owner/Agents Date
BUILDING PERMIT PERMIT#
DATE VALUATION* LOTTRACT.
JOB SITE
APN
ADDRESS r
47•-905 VTA =R -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
C"ADAY'-AND�C3.tvLPANY
'HAL HPO K0;4 alba V,A4:AXION-POOLS "
'47-1065V'.-AANUE��
'952'ZD0, N"_3QNlRD,
�..AQ:UWrA . CA' .92253
CCA
92356
filD). i-6°�b•'13
CBL1-
4335
USE OF PERMIT
POOL ANWOI< SPA
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; .
-
INSPECT 1014, POOL 17,QUIPMMI d''E4dCLOSURE'NOT INC .IUDED
;
POOL t rl '01% a� 4i:.' ,. I4ow'.001.9 •-
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a
�gy
• ..` �• di.�i.•~ b :el 100L1}WfE• T.pp1140
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PLAN CHECK . TE $10130
b E� Tc6� FEE a *0 --0r 411' .0oi�
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AYE Z01H t'bE' ICIa,S7Si} "' i'-4�M1�- .,.•t y�il 0.1;'000-42•1'l7VV
i&i� tCTP.1CAL:,PEI? �F 1�t1t7L>s � i„101 CFQt04
P-1 UK6TIN a ice• - P 0 0G =' ti: ` £ ai,�:«�rj�
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$N3.30-
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IRECEIPT--.
DATE'BY
�r.�
'
AT'
bF NALE
INSPECTOR
(
il
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
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
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)