9610-042 (RPL)LICENSED CONTRA(
1:1 hereby affirm under penalty of perjury
Chaptee 9 0cornme.ricing with Section
Professionals Code, and my License.is i
Jer provisions, -of
ie Business and
License' ass Date
qty h3.�unature of Contracto
. . " - 1, - e
Date'
OWNER -BUILDER DECLARATION
Thereby affirm un'der'penalty of perjury that,l am Ixempt from the_C6nt . rpctor's
License Law for the following reason:
1, as owner of the property, or my employees with wages' as, theirsole
compensation, will do the work, and the structure is ❑60ntencled or off ered.for
sale (Sec. 7044, Business & Professionals, Code).
1, as owner of the. property, am exclusively contracting with licensed
contractors to construct the project (Sec. .7044, Business . & Profess'io'n ails
Code).
O I am exempt under Section B&P.C.* for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm **. ' under pepalty.of perjury one of the followingdeclarations:
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'CodeAor the performance of the work for which this
.. 6 T;kl I PUNO ,
permit is issueW My'workers' compensation insurance carrier & policy no. are:
Carrier. Policy No:
(This section need not be comple.t.ed if the permit valuation is for$100.00 or le4),
O 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.-gs—to bedqrnie`subject to the
workers' compensation laws of,Californ�d agree that'if I should become
subject to the workers' compe I n s - . ti ripfov , isions of Section 3700 of the Labd . r
Code, I shall f with comply ixq ose:.O.rovisions.
T rIlp w
Date: 1�11 �14 1114. . Applicant'id 17;16
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up,to $1 00,006,; in
addition to the cost of compensation, damages'as provided for, in Section 3700.6
of the Labor Code, interest and attorney's,fees.-
IMPORTANT Application is hereby made to the Director of BuilclingBnd Safety
o .
for a* permit subject tthe co I nclffions. 'and 'reStrictiohs set forthori, his
application.
'11. Each person upon whose b ' ehalf this application is made each person at
whose request and for whose benefit work. is performed under' or-pur . suant to
any permit issued as a result of this applidaton. agrees to, & shall; indemnify
& hold harmless the City of LaiOuinta,Jts officers, agentsand employees.
2. Any permit issued as a result of this application becomes nulland.void-if
work is not commenced. within 'l 8.0 days from date of issuance, of such
permit; or cessation of work for 180 days will subject permit to cancellation.
certify that I have read this application and state that,the abov I e information is
correct. I agree to comply with�'all City, and State laws,relat . ing to the . building
construction, and hereby authorizKee!presentatives of this City to enter upon
the above-mentioned
' pr -
ery` I
/_4SpAe
ction purposes.
Signature (Owner/Agent),
—T -T
PERMIT# ' , - i CONTROL #.
BUILDING PERM'IT 420
DATE 0/1 .6 VALUATION S2,0011.1.00 LOT TRACT ..8'
JOB SITE
ADDRESS
OWNER
CONTRACTOR DESIGNER ENGINEER
T I'm
� k4fily. POOLS COIN 7pllur4r,.0�1'
3-5 ['A 0 V U
5.3366 AVINWA RAIVIINLEZ
* -N-_ I
UXQUI CA, "5:
A
L QIRITI'A CA 92L53
(091).504 3 SS rB -0 2803
0.
USE OF PERMIT
DICR. f 'A
fXXA. ANOSWA,01411X,
4n ' A eka,f
"YLAN CHUCKYRS -3D 1,-000-439- 3 18 7. S1.4Q,40.
101000-410�000
4,10.111A.14CM, VETT'� 101<t'/{'70 -424J•^!` - 00 VA. N)
ft"11M.0[W3! UNto 0-,i 19-600
-, StIR_)NA.N0ftAN0HECK RMALC0101101
SUM, -K
L'1$S )A11D'P.Ef1so-0).
VERMFf 1TIKESOU li","NOW
$452.40,
OCTTo
1996
RECEIPT
DATE
BY __FDATE
FINALED
INSPECTOR
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
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric IF
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
Gas 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:
-4350 Ville'
gU4(
am s JD
C®n'S#'UCtion
Pools. Spds 'Fountains
(619)564-73655
:_,Lic. #65899s6
- y
r: . .
gU4(
am s JD
C®n'S#'UCtion
Pools. Spds 'Fountains
(619)564-73655
:_,Lic. #65899s6
DC
CITY OF LA QUINTA
BKMNG'&8AF5VDEPARTl;V7-
CONDMONALLY,
ACCEPTED FORDONSTRUCTION
,r -,Lii,,1ECT MINSTALLATION AS PER