The URL can be used to link to this page

0204-223 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisidns of Chapter 9 (commencing with .Section 7000) of Division 3 of the Businw_'Znd_ Professionals Code, and my License is in full force and effect. License #4 . Lic. Class Exp. Date C_53 19C 01-8 1014; Date ,. _ - Signature of Contractor ri f 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 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:. Carrier IT NrrC '%O1+f1pp,W .f T� Policy NO. -046000168-0). (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,Q provisions of Section 3700 of the Labor Code, I shall forthwith comply with ose provisions. Date: ' ,If 0 Applicant � r 1 Warning: Failure to secure Workers' Compensalion coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section.3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each personat whose request and for whose benefit work is performed under 6�r pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. . I certify that I have read this application and state that the above information is . correct. I agree to comply with all City, and State laws relating to the building, . construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) 0��4. Date � W , .v B:UILQINOPERMIT PERMIT# 'DATE VALUATION 4126!£) �,OQ1�i i3t� SOT TRACT JOB SITE -^.p ADDRESS 4" '. r Lased' J10 APN OWNER CONTRACTOR/DESIGNER/EN (NEER T.D. DESERT DRV L0rXbV_WT t.: AT`IF0WIAPOOLS &, WAS (XP MAW C0 1.10. BOX 3 7 16 74?2,$ JONI lMfM 0VITS 41 �, LA QYTd IA CP. 92253 r- 'ALM Dwaii' CA 92260 cm)340-9000 GLV— 00355 USE O��/!!yF) PERMIT � �j�} �S �j f� ,�P0V.hTl�1LflJDf0.R 1�.7.�"�i`4 B13©�(pt�l.1`•tfySAp��gtRy��i$+�SR�.1y9(y�1�5�'y)y.�p� Ln1]{.nsi�ty."Phffy$x/i�/.RS,�):R1EP9r,,S S[3s3y/,�,c.�.J, f1�8 - 77''�O�O(L,q,{�"I��;A,, 66`7 S�l+6Yi�.Ro.t"4i PRIS-S�I./.R9AlER I.S`I�.J"W.TION, 8"'N4�W' 7 �1.rfYd A?A`F 3 ?�Ci,#.,3St.5LiL5 �10't' YtdCLil3!✓L]. ` POO] ' 4v:DIOR SPA 24.000.90 ids c ' :iWII&0 COW 0:r CDHS11MMON 2.14,M.00 Y'. 14 CHECK 1 101 X000.1,29.3) €t $01W0 MECHANICAL YEE •- POOL 101,006' 121 0000 W,CTRJC.., k,1!'P.t. -- POOL 101--001.-420-000 PLLTMLN0 i& E •• ML 101-000-41_q400 X ±c : 3»`1'C3 ` r :i • :f G°T O r AM T"LPJ.IY CHF110C �D $496.95 sMESS PRE -;PAM VM $0.00 APR 294 200z" 1 REM= 11MA D WO' COFLAQUIRTA FI � FINNC 'DEPT �M RECEIPT • ' DATE s" BY t � _ DATE FINALED INSPECTOR RT 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 OX 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 _ _z Set Backs Electric Bond — G Footings Main Drain BO d Beam Approval to Cover y Equipment Location _L— Underground Electric — — 0— Underground Underground Plbg. Test=� Z 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 Fina 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: -