0110-237 (RPL)v, ' LICENSED CONTRACTOR DE
I hereby affirm under penalty of perjury that I am
Chapter 9 (commencing with Section 7000) of..Di
Professionals Code, and my License is in full orc(
C53
Signature'of
OWNER -BUILDER D
icensed!under provisions of '
ision 3 of the Business and
and effect. r;
Exp. Date `
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 s'.ructure 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 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:
cCarrier RI`ThTV YUWD Policy No. 13Qt3 3 -Q2
(This section need not be completed if the
( ) I certify that in the performance of+tt
I shall not employ any person in any�rrii
workers' compensation laws of Califomi
H subjectkto t e workers' compensation pr
Code, I gh ll forthwith compl6ith th_ os
Date: !4 1 ` Applicant""
Drmitwgluation is for $100.00 or less).
46rk for which this permit is issued,
net so as to become subject to the
and agree that if I should become
isions of Section 3700 of the Labor
ovsions.
Warning:'Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penali6 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 cf such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this
correct. I agree to comply v
construction, and hereby at
the above-mentioned propel
d Signature (Owner/Agent)
ation and state that the above information is
City, and State laws relating to the building
representatives of thisCity to nta .upon
nspection purposes.
Date
PERMIT N -
BUILDING PERMIT
0,x10-237
DATE /f / VALUATION'" r LOT. TRACT
Fb4'�1
l_ ..} �C'Y�75irY1'V
ADDRESS -1i?"4 +ha�dtl. JOB SITE
APN
OWNER
CONTRACTOR /pDESIGNER INaE�EER
MR. !,3,4✓ORg�uS,iUqy1
�y^
.CaS`lAC.1,.1.7�5� %\,/i.e'LeeY `.+'�.[V1:7 i.3♦.4i'tn,;r.l..r'T,G�FC
LA QiT�,iil lf,, CA :i.2,12M
LA QUIMP CA 92252'
(�60)564-3655 C71 -L40 2993
USE OF PERMIT
POOL ANW0.1Z EVA
PGG SFJ%1I0Q, . -INNI .,#IeSX�e3FJ�,. t Ld° wi1f .A ,k.f:t+rt � tYe��S Eft
Ix,' PJ hCF AT PRX-PLAISTER lNISP-ROTIOXV, PWS, PQUIP.MKIT
'RNIi+I:.03u:plz NOT Tf40AiY3X0 .
POOL ANC:9IOR. SRA 00 W
MMAI C osr OF COMT ,RU4,:T'ION
9161MOM
r�' A.H! CMICK "N2, 101-130 DaI4 39-3 i 8W111CHANIChil
f�°C9�dSi'��,171�;'.d'e0'�# f'"�?;{'r Z�3-f;P(f�J-��:t�••t3i?a �Jct�.GO
FEE __ M�L 101-000-421-000
!)����:{q'gi'��j4T3C//AL'tfiA'L .T�(701,
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il�{iJp��
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P1;0M,,P;,bgG, diS , 0,006 01-000-4L�a��Lr' )Q ` iPB lil+4�
' NOV 0 5 200
e CITY ®F`AQUIN
CF rtrxl�
Z.
- y AC�CG0_l—TOTL CONM VJC,i"1TD :
$4 07.85
E p -PAID FM
1
RECEIPT
DATE
f
BY
DATE FINALE
INSPECTO
.`
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
Bor,q Beam
Approval to Coverw
Equipment Location
h
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
Gt�s Test
Appliances
Final
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:
-