0001-262 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I ) a . m.licensed under 'provisions of
Chapter 9'(commencind with Section '.7000)'bf Division 3 of the Business and
Professionals d6c!6,i'and my b6en�sii is *6 full force and effect.
L
-�i ic.
"ci-
ass Exp., Date
N c-53 -8r 12/311/201
to /A
"'Date`gnatdre of Contractor
OWNER -BUILDER DECLARATION.
I hereby affirm under penalty of perjury
ury,that I am exempt from the Contractor's .
License Law for the following reason:
(' ) 1, as owner'of the property, or my eniployees, with wages as their eir sole
.compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
1, as owner of the property, am exclusively contracting with li6brised
contractors to construct the project"('Sec. 7044, Business & Professi6nals
Code).
I am exempt.under Sectioh B&P.C. for this reason
Pate Signature of Owner
'WORKER'S'COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
. ( ) I h ' 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 isissued.,'
( )I lhave and will maintain workers' compensit& insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permlit is issued. My workers"c ompensation . insurance carrier I & polic . y no. are:
Career Policy No.
AT1311i"UN-1
(This section need not be completed if the permit valuation is for $100.00 or less).
I certify thatin the.performance of the work for which this permit is issued,
.1 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' compensation provisions of Section 3700 of,ttfe Labor
Code, I shall forthwith comply With thoisie,prov cions.
Dfate: Applicant—
Warning:. Failure to secure Wo'rkers' Compensation coverage is unlawful and
shall subject an , employer to criminal penalties and civil fines ul5t'o $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 erson upon whose behalf this application is made & each person at
whose request and f6r 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 LaQuinta, 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 fo,r.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 /this City to enter upon
the��above-menitioned property for inspection purposes.
SV ;C4 - -7'� �
ignature (Ov�r,'er/Agent),.,'�l/`�""` Date 41 ^ 0
IN4 W -A
BUILDING PERMIT - PERMIT #
4,
DATE
VALUATION 3,,,%(kA.fi0 LOT 81r) TRACT
75953
JOB SITE
.9(,Al A., V
/ADDRESS-
OWNER
CONTRACTOR DESIGNER ENGINEER
C. 11. POOL COINSIMJCAa
7900 -AVENUE OFIRE STA XE S
68-465 PERE .%d
PALMDESEIrf CA. 92211
CAIRIFDRAL Cl."FY
CA
92234
(760)328-26811
cpal"a
69 -
USE OF PERMIT
TOOL AN—I.A.-A 8-J'A
POOL & SPA, SHkLL BEM PLACE AT XCE
fli.A' STF97 INSPEC.11UN'
FVkJL NIDIOR".03PA. 1, 500-00 LS
,d' wet.
A. J11.
VRE AMMARV,
e'QN,';r'f RI -R7 1110N FE'Ft' I 0i 4ft-M 8-0 J
NIECITAWICAL FIMi — V0 .L 101-0,00-42I.000
ELECFRI L M-13. -- P(7r,7)L .101-000420-00
PlIUM.81NO k,'ELi— YOGIL .101 -000 -41!? -000
ti
IS UD-TOTAI, *014817RUCI AND 1, CH .C.,
toj-
'f0l'AL1,PORNITO.' MEN, D'OE: NOW
$348.45
RECEIPT
DATE
BY(j
DATE FINALED
INSPECTOR
IN4 W -A
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
Steel
POOLS - SPAS
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
.cab
Gas Piping
Gas Test
Appliances
Final
-. Z _C0
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)
COMMENTS: