0202-113 (RPL)LICENSED CONTRACTO"ECLARATION
I hereby affirm under penalty of perjury that 1 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
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).
( ) 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.
-) 1 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 , Policy No.
„(This section need not be completed if the permit valuation is for $100.00 or less).
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
workeis' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor,
.,.Code, shall forthwith comply with those provisions.
�
'Date:'.,— f Z, 1& e Applicants'.- t a'L
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, i
addition to the cost of compensation, damages as provided for in Section 370
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject. toy the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
Whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and V. id if
work is not commenced within 180 days .from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify-that.l have read this application and state that the above information is
66rrect:•1-agree to comply with all City, and State laws relating to the building
'construction, and hereby authorize representatives of this City to enter upon
the?above-mentioned prop rrty'forjinsp tion purposes.
Signature (Own er/Agegt)- - - rr - i„ /�� "tµ Date-
BUILDING MPFRMTN
'PERMIT
DATE VALUATION LOT -�e;Y6,V ,9 y TRACT
JOB SITE
APN
ADDRESSy py p[y�
7i� J.YIV V.@.4,sPd•ifi.�iIA NJ.L'i..KUA�'+ •-
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OWNER .,,
CONTRACTOR / DESIGNER / EN INFER
DRd3i3 F AMOY GARM
GAM0'80 POOL PLUMMG, rich
19.160 %v-ca,CAptm: ?. :�
667 B€1MIRD,
T'AcAyl r.& t:: k 9225
PALM CA 92264
(76opv—' 592 816
USE OF PERMIT
PC3OLTD/Ori STAA
POM &SP.A. 0.14L:'RALAR NI',:fi ARRI,ikdtS SHALL BY W V'1AC9 AT PR!?
P1,=121 WSPE C"rION,POOL EQUIPU i?i4T F1,tVe OSUt"X 35 NOT itItom`wmb
TEFFS.1`�ERMIT.
P'OOLAXWOR. SPA ).1,006.,�d yrs
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6l.y�y6.'Wv 0•ter*
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$-1YATiAff F.E. E SOMMA7RY
PUN d:>; ECK21 '101-000-439-318 $W190
CONSTRUCTION ION E 101.0.00-418-000 $126.00
l'tfiE: b'1 NIC -AL, F99 .., FOOL 101.000, 421 000 SX00
tp TPUCAi. Fsp-a,Pt:?mn ' im-clo-42o-000 WAG
p3.tJM1;.1N0 Frit • f 101-000-4M,000 MOO
F EB 1.3 2002;
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I 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
Equipment Location
Underground Electric
-
Final I I
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
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Uriderground 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: