9807-042 (RPL)LICENSED CONTRACTOR DECLARATION
1•here1;;j 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
Professionals Code, and my License is in full force and effect. Ma;
License# Lic. Class Exp. Date
\ a
' 3948 C-53. 7131/99
Date'l—/ _41— Signature of Contractor
1
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 r
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 Policy No.
tai T FILL
(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' compensation provisions f Section 3700 of the Labor
,Pode, I shall forthwith comply with those provlslo�is, 4
0 Date: /f "tea; 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. 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 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 i ove-mentioned property for inspe tion purposes.
Signature (Owner/Agent)i "t=Date
BUILDINGPER�M,IT PERMIT# CONTROL#
G
'd�f►'l-�' 4'a4
DATE VALUATION ' '. LOT' TRACT
�- �6 - 8 81!,0100, 8 0' 5
JOB SITE .y
ADDRESS 44-330 N -1:1.L E A DIR
APN .• 1
OWNER
CONTRACTOR/DESIGNER/ENGINEER
• PRAME'_ W & ,NMARSTIA L 0 RISCit>'N
RAZO P0ia S
443-10 VILI.'r A DR
82756 90S": OIN Cf.
LA Q13TNI'A CA 922.53
'IND10 CA 9`'2201
t'760j347-161.7 Ci ITA. 26114
USE OF PERMIT
POOL
I'0el)USfaA, ALMW36AidiZ. ERS SHALL BE IN A`i' PfX.41I.A8+T2:3Td
1'1�54'ksf;'i`10�1
Pf,.k11, HVT/JV1.4.:8.1'14. 14a000.00 3..3
'ffi�a"13.aa.�iMW
PLAN CtEc:s�..VFF 101-cM-439-3114 X49-0
CO IN' TRUC.ITIONF-Ri 101-000-418-000 $453.0
MM-"IC:ALFEL-,.POOL 101 -OM -421 -DW
1 LS C'6'1 JCAL PEE — POOL, 101 000-420-000 W.00
PLUFNI NG rETI, - POOL, 101-000-419-000 S27,OU
a
1TJPTCfrAT,
$34� 45
C0N9FR 1zC r10N A11-40 :1'I,AN CHECK
ler
f, /' • ✓ .- _'� �' I.FSS SRL-PAW FUS
$0.00
t . iggg TOTM, PERMIT �'c�;f: S �a1(xi NCM
$348.45
^
RECEIP`>I,
TE` '
k-0
BY
DATE FINALED
INSPECTORIVIi.
s
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
Aj 100,
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
_,Z —
Underground Plbg. Test
- -4
Final
PLUMBING APPROVALS
Gas Piping
Gas Test
Electric Final
I L A
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Volt4ge Wiring
Fixtures ; •
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
UtilityNotice (Perm)
COMMENTS:
•T
I
CITY OF LA QUINTA SUB -CONTRACTOR LIST
JOB ADDRESS y ��y. G �e�� PERMIT NUMBER OWNER l�®x►,yk Q �d�i���A BUILDER klqzo to�'LS
This form shall be posted on the job' with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes.to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of build' ing permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
..
:Cit Business>Ucense`>'`
on actor.:a: license.;:.; .. ::..::.::::.;.:.:::.;:.;:.;:.:.;::;::::::.:;.;:.;::.::.;::.: ,Wotkecs.;Coat ensat�on.a.n. surance:.;:.>:> .. ..... Y
Trade / Class�lfication :;w :•:: .:..Contractor k::::>f;: ..;:.:... :....:.:::. State.: C...tr .......... _.......... ...
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx)
Exp. Date
(xx/xx/xx)
EARTHWORK(C 12)
-�:, r.: :;/, •i"�''. :�uf',�
C•- z
�/ r3t3
2-3/•?
57X'7 " /-owp
CONCRETE (C,=8) "
1 `.b /�'Ai"'�t11� , .0
-(�/ 0 -(o
Al %2/8 %
FRAMING (C-5)
30
STRUCT. STEEL (C-51)
R4Z� ;
15_739y8
7-:3/- 9
EiCE/�7f�7'/O/✓
-tom
2 ��
3 -!c - yY
MASONRY (C-29)
PLUMBING (C-36);
_l-
a2 �8
LATH, PLASTER (C-..: 1.
- .
J Qaol SSI yc.�
- 3
/Ob gS
- 3 t - Q
DRYWALL (C-9).
HVAC (C-20):.
ELECTRICAL IC. .1 o) .
j
50. m
CSS o Ve-
3
3'
ROOFING
SHEET METAL:IC=431'"
FLOORING'(C`-15.)'
GLAZING (C=171:
INSULATION:,(Gr2)
SEWAGE DISP jC
PAINTING (C-33)'
CERAMIC TILE:
�-ZO P6 D�Svh
CABINETS IC=
FENCING (C 13)
LANDSCAPING (C=27)>::;:
POOL (C 53).':"