9712-020 (RPL)' LICENSED CONTRACTOR DECLARATION
•'I hereby affirm under penalty of perjury that I am Jicensed,under provisions of
Chapter,9 (commencing with Section 7000) of Division 36i the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
57394$ 0r53
/Date IYY� c/- 5 Signature of Contractor—
OWNER-BUILDER
ontractor 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).
as owner of the property, am exclusively contracting with licensed',
contractors• to construct the project (Sec. 7044, Business'& Professionals.
Code).
O 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 Policy No.
- EXEMPTION ON FILF.
(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,
Vshall .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 shall forthwith comply with those provisions.
/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.
/Signature (Owner/Agent) . Date�1-��f -J
PERMIT# CO�N/yT�R/O/�L#
BUILDING PERMIT
DATE VALUATION _ LOT: �1,7rn2� TRACT V. 6,. 9,6
1,2/4/97 $13,800.00
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'MR, & MRS. KENT.
RAZO POOLS
74-240 VICTOR.i,A.
814756 BOSTON CT,
LA QUIN"I'A CA. 92253
INDIO CA. 36201'
(760)347-1617. CBI,-#. 2638
'
USE OF PERMIT
P(XX AND SFA
POOL ANl71iw R SPA 13,800.0k1 LS
ES1'ii IAT:Ev COST GF CONST41:1)C Ij'I€31V
�3,n1►di.110
PERM EE, SfJNI tARY
:PLANC4F4Ci FE -6 I01 -W0439-315 $99X35
CONS'IRUC110NFEE Ifl1-000AM000 �15�.(►U
NtECi AWICAI FF,.lr --• POOL, 101-000-42.1 ON
ELECI►tICAL i; -V, — P06L t 143-000-420-000
a VX,5ds0
PLUN481NG FEL -- POOL ' 101-0i10-119=000 �1 '
AI
DEC 0 4 1997
i
S11F3-'1T(7'I'AL CONS'1%FTFY1 td RF; f1, , NTA
$348A.S
.
LESS PRE -PAID FEES
TOTAL 1PEItNUt FEC$ IYVE-NOM'
$348.45
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
J'I
�1
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
Set Backs
steel
Electric Bond
POOLS - SPAS
�/6�
66��
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
A13tZF7
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lan+ Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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. -, M' }. �, �. '�,: ;' , y-+ I� 'lti �.i Cyt i"� .�' q: � r...� ..,oma-:s.`F �� r.. y' ... ' -- r �';' "-ti' �' �': w .•.�:t�' '11 -. i
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CITY OF LA QUINTAL z
SUB -LIST �3
A.-
CONTRACTOR—'64 Z O • D' e_C L_5 ADDRESS
OWNER— If e ry -7 JOB ADDRESS -71 ^ yU C nei<
This form shall be posted on the job with the Bui1ding 'Inspectian Card at 611 times in pus placer
It is the responsibility of the General Contractor or the .Owner/Builder to monitor the sub -contractors that
are on this list,are the same persons performing the work. Any changes -to this list must be approved the'.
-City of La Quinta Department of. -Building" & Safety'pliaE twwork.being performed by a changed sub-
contractor: Failure to comply will result -in a stoppage of work and/or the voidance of building permit.
CITY •I
SUB -CONTRACTOR'S
TYPE OF
STATE
WORKER'S
BUSINESS.
TRADE
NAME
LICENSE .'
CONTRACTOR'S
COMP. NAME/
LICENSE t?
LICENSE
'NUMBER. ON FILE ' -
.NUMBER/
NUMBER:
EXP-. DATE
GRADE/
A/C -12
73..7 3 1.7
V �`�qY�7-4
41633
V40
Cu V.
u l -
4 Fs u .
EXCAVATE
�LI c • y
5/1146`
ego 1,6►
q$
PIPELINES
C-34
.
CONCRETE/
'C-8
FOUNDATIONS
ASPHALT
A- +=
FRAMING
-
B
STEEL/ _ '
C-5.1
STRUCTURAL
�.
MASONRY
C-29
3►
r
PLUMBING
2 � ooLS
- -7.3
_
LATHING
C-26
DRYWALL
C_9
F .
PLASTERING
Lv , �c: L
C
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it S �4�d�FKJ
3C
HVAC
C-20
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ELECTRICAL7
31 q$
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,
(General):
2O ro�,L
C ,S3
7-3 9y
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ROOFING
C-39 .. ,
SHEET METAL
C-43
FLOORING.
C-15
-
GLASS/;
C-1.7
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GLAZING
INSULATION
C 2
'
SEWAGE DISP.
...
C-42
-
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PAINTIN61
C-33
DECORATING
TILE
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5'73!? -yr
CABINETS!
C-6
INSTALLATION
-
FENCING`
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C-13
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LANDSCAPING
C-27
POOLS
..
C-53 ,
OTHER
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