0106-070 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I 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
Date&pS Signature of Contractor b/e
✓�
_• (..W.NER-BUILDER DECLARATION
.I -hereby a m 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).
(j I am exempt under S26ti6n , B&P.C. for Phis 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
Se on 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� 1,q Policy No.
STATE COMSATI
(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' compensatio provisions of Section 3700 of the Labor
Code, I shall forthwith comply with t ose provisions.
Date: Applicant ¢+-
Warn ing;_Eailure•to-Sec ure"Workers' Comperisation coverage is unlawful and
§ iali 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- hi"s:
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- r
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 r
the above-mentioned propertj for inspection purposes
Signature ,,,(Owner/Agerit) %•. Date
BUILDING PERMIT PERMIT#
/
DATE f p{' /// i VALUATION LOT W.06.0110 T4 T
J06'SITE f
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
4',C,), .' 911K 1716
74125 JOU D.M. SUIXTB OA
LA QATINTA CA 922S.3
PALM DENERT CA 92260
(760)3,4040d_00 t 33i;i 355
USE OF PERMIT
P001., AND/0R, SPA
POOL & STA CJ?d.LY PWAI ' I`DY-S 7400 i'idCLUDE HLOCK WALL. ALAR M1,13
'
AftZ R30T;tZED TO HE INS'PALUM RMOR. TO ENCAP rMSPEC'T'ION. � ':•. ,;�.
PCSOL ANDIOR SP.4A �i4Y�U.bD 1 S
PUMM FM lb'aIDAMk` RY
PLAN C:*TT?CK PEE 101 -000-439-318 9146.25
CONSTRUCTION 2''E'.•E, 101.000418-000 $32.%.00
MECHANICAL ,W -2--P001, 101-0001421••000 $24,00
1¢1 tj:C'3`RICAL. M — POOL 301 ••Wi3 4120-000 V13.00
PLidMTsf'Nt:TIaT E P00b 101-000.419-000 $27,0
' SUBM- "Cri0 MAW P!<ON CREECX
S467,25
LESS PREPAJDYEFM,
$0,00
PERMATl' i1'KFS .OUR N (YW
S467.15
I b t11�I z
BY
DATE FINALED
INSPECTOR
pRECEIPT
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
Gas Piping
Encapsulation
Gas Test •
Appliances
Final
COMMENTS:
I
Final
Utility Notice (Gas)
_
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Mai i Service
Suh Paneis
Exterior Receptacles
G. F.I.
Smoke Detectors
e of Power
k__M7:__Us
.14al
Utility Notice (Perm)