0102-163 (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
Profebvignals Code, and,my License is in full force and effect.
Licens �y;,j Lic.•Class Exp. Date
/ &tel .0 M
0102
UZ
Date Signature ofrContractorR'
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 thisreason
Date{ Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
CarrierPolicy No.
T,t Fi-,"ID 046006A68-00
This section need not be completed if the permit valuation is for $100.00 or less):; ,
O I certify that,in'the performance of the work for which this permit is issued;"
d
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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply wit, t : ose ro ion 5
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.
_application.. 1. Each person upon whose behalf this application is made & each person ab
-whose request and for whose benefit work is performed under or pursuant toll
any permit issued as a result of this applicaton agrees to, & shall, indemnify
Ahold 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• isnot 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 dorin pection I doses.
Signature (Owner/Agent) y rA >j Date
BUILDING PERMIT PERM T#
DATE VALUATION_,.
LOT' Q�r•� 63 TRACT
1 y1
242110111 +IDX•sli' b7�,M{cA749 ¢ 7 f
JOB SITE
APN
ADDRESS
.405 NITSTA X, ,l;tdA
OWNER
CONTRACTOR/ DESIGNER / EN INEER
T10. DME QMTDiR;GTD::eaisW: T
C' 1AY..)RAttTTA.ia00i3 &SPAS
Y.Cp, BUX,1716
744 25 3QN1 LYR,1VE, 4A
7A Q1 1'h CA. 92253
r ALM XM SERT CA 92260
(760)340.9060 C BX,# 5.386
USE OF PERMIT
T1001 ,ANT,>}'!Uia, SPA
l��L.I.OY,/��►J1�.Y;ftp.r'I:kbtZaR�*s�a1�����Y�'�:�i.`t'�+3,t+t5'l446.A.CF.e1.i. i
s�,L.�,,R:Pua'8k3a�b'��tYE����Y ;�.is�A3�1� k4� 11� �1.,,s�C.'�:.�;T `�'" •�i.�A.ST3;� I�til�'!?66"'�QC►l�t.
POOL E(,?V1PN! "fqT 04CLL:JIyltE 13%fta'r 114Ci,L DED.
s PryOL ANDIOR S.Wh a X0.:7 LS
'wa>
u. E{grMWMICOST O C4 RSUMMI6, N
�y �77y gry�nyy 7
O )'NN"d lis lfi�Ntin $265.(NJ
)a�:s�C 17Ri All t"FI1:.- F&L 10 1-000420-000 345.00
PLAN30HO FEE --Pool, ,101-000--419-000. 52160
FEB 23 2001
Y u k Lj-% W-4®r..4l;_ l":ONMRIM i` MIT AM PLAN MMCK
-AT 1r 7
t�alJ. f3�
RECEIPT 'DATE
BY ct�
DATE FINALED
INSPECTOR
-.l
INSPECTION RECORD
OPERATION
DATE
INSPECTOR. OPERATION
DATE
INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set cks 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 Wail 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 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
COMMENTS:
Final
Utility Notice (Gas) 777,—'j
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)