0303-204 (RPL)LICENSED CONTRACTOR DECLARATION
| hereby affirm under ponanyv/pe�u�that | am licensed under pmviYionoox
Chapter (commencing with Section 7000) of Division oofthe Business and .
P��aoiona|uCode, and myuoonooioinfuU�meand effect.
uoon�# uo.u/mm Exp. Date
238947 C^53 ` 31/04
-___�����_��� Signature_of Contract
OWNER -Bu| ~ �
|h��ya�mv�ep�a��pa�u�m�|amo�m��momCom�nmr
�oenooLaw kx�ehdm�ng�aoun:
( ) |, aoownmo/me property, o,myomp��mtheir �
so
oomponvonon.vwnUomowmm.and mo�mommionmm�for
s�o<oov.7o44.Business upm�oaiono|oCouo>.
( -) |' aa'owne of 8m pmpe�y, pm exclusively contracting
contractors m construct mo pm�o (Sec.7044 Business u ProfessionalsCodo.
(>|amexempt under aevnon_smPouxm�m000n�______�_
Date Signature mOwner
WORKER'S COMPENSATION DECLARATION, .
'
| hereby affirm under penalty of perjury one of the following dec larati ons:
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 w6ich.this
permit is issued. My workers' compensation insurance carrier & policy no.. are:
Carrier Policy No.
completed if the permit valuation is for
or less).
I certify that in the performance of the work for which this permit is is I sued,
I shall not employ any person in any manner so as to become subject to the
workers: compensation law's of California, and agree that if I should become
s to the workers' compensation provisions of Section 3700 of the Lab�
,,Gbje, I shall forthwith comply with those provisions.
��e�n�� be$100.00�mo�u ,Co�.in���mm�mmm/a��.
Warning: Failure.,to secure Workers' Compensation coverage is unlawful and
shall subject an employer td criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided,for in Section 3706
IMPORTANT App|monun�xo�uymade mthe oimom,oxouiminoand Sa��
m, o permit subject m ma conditions and restrictions set forth on ma
application.1Each whose uehoxm�opp�a �made &each person at
whose request and for whose benefit work is performed under or pursu ant to
any permit issued as a result of this applicaton agrees,to, & shall, indemnify
m hold harmless moCny�LaOuim^. its officers, agonmand employees.
o. Any permit ioouou as o result oymiv application becomes null and void if
work is not commenced within 180 uaxo from date of issuance of such
permit, o,cessation ofwork for 18Udays wiUou�e�permit moanuonouion.
|oom���|�v �d�����o�n�do�o���oo�v information is
«onro | ogmomcomply wim all City, StateonU 8|owo m|ahngmmobuilding
Construction, mm
d hereby epmdontauvonufthis City toenter Upon
x 'mononnod propertyfor inspection purposes.
Signature
BUILPING PERMIT M3404
DATE �<UATION Lo' TRACT
Ila
JOB SITE 4$405 WS"I'A CXTACO 1,40
ADDRESS
APN
OWNER
CONTRACTOR DESIGNER EN61NEER
W'.)13 WATCOLIat
R, PC) 01161
LA QU.04TA CA 9:2253
PALMDromer CA 92260
(760)3465-6115 CTIU 0016
USE OF PERMIT
P. 00LAND/M SPA"
5.FT1 WALL 4,00 LF
POOL AND.10-1Z SPA �5,914.00 LS
CONSTRUCTION I% H: 10 1 -060z.4 18-000.
MEV,HAHWAL FER POOL '101..000-421-000
XLECTRXAL I?ZLP .. POOL
CITY OF LA QUINTA
WQW AIM PLM fY3ZC%
RECEIPT
DATE
BY
ATE FINALED.
INSPECTOR
- � (Owner/Agent) =�
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 Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
!Nater'Piping
Plumbing Final
Plumbing'Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
_ 7_
COMMENTS:
_ ..
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low V#,3ttage Wiring
Fixtures _
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors `
Temp. Use of Power
Final
Utility Notice (Perm)