0208-252 (RPL)LICENSED CONTRACTOR DECLARATION .,�.
I hereby affirm under penalty of perjury that I am licensed under prQvisions-0
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Licensed�# Lic. Classy Exp. bate
90180 7 '4s 1'.15. 12/3112(
Date Signature of ContractorA
�^ OWNER -BUILDER DECLARATION—-` *
I hereby affirm under penalty of; perjury that ltam exempt from the Contractor's
License Law for the following reason: /f
( ) 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:.
Cartier 11MEMPT Policy No.
(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 of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant Gla
Warning: Failure to secure•Workers'`Compensatioh.co- verage is_unlawrful.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 above-mentioned property for inspection purposes.
Signature (Owner/Agent) A Date
=� =�• BUILDING PERMIT PERMIT
-'
DATE,,.•-uA � VALUATION ,ow•m LOT TRACT
JOB SITE
ADDRESS ' `�l�•J�-.l!p°n.E�sRiite•
APN -
OWNER
CONTRACTOR / DESIGNER / EN (NEER
D air, CMCLP,
1.UM0N'li .900U9 AND aT AB
33-7'7511'VIIXLE Li
17 .10 0 'KNt� .'LD EA Uf M E
Lt'3.1~jLYIM' A 1.1.11k 922.53
�/'+.�Ae}.,.,(tir:(.��ggtE+a��'AT (�.•.�ary �"�221 '1_
f
y gyp
(I60)1b�d�f"`5 q� CB0 1. 4,158
USE OF PERMIT
POOL /C. k RPA
POOL A.,,3VA ONLY. ALA:KM xtt!~iAR1UXAZS SHALL BE D4 PLACE PItdGR TO
PRE LASP'P M 9i SK47',T`I YK POQL fQUIPWN—T£CLASUNII NOT INCLUDED,
IN PI3i MIT.
POOL ANDIOR SPA ","Oxo 'foa
MWATM) ) CC U'r OF CO1�'�ERUCTOPT
P1,44% 0MC K FRE. 101 -000-439«31.8 g1 c84,9
Ciii,4STItCICTION NEE 101 -000 -418 -WO
X UCT UCLAL FEE — POOL 1X71-004-420-01 3 S0.W
i� 1$1f f1 f [�iCr,T 'E?i�'L d to -M5,419-0-00 *M90
M
�f
8fla-TaL STiRUCr(ow 47€)T+3??pa��JpF�4''t
1,01 �!Ffq.€��.(C�(���.
�i A1y'r, 2 2 0TX',l.E.i..C.7eS:i:.{@'H& rL`X67 DMKI.L'1'4WY?fw
CITY OF jLAAUINTA
FINANCEDEET x
jy
RECEIPT
DATE i% l Pa ,_ BY sr#
DATE F ALE
IN P R
EZ
+� ' �ti* iii #Rs' Iq`, :,S Elia¢►i�ba`�;v a ire �+ s s to „eb�Syisi! 3 ti�+�«� '" summa E z/; snuun w
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
POOLS - SPAS
o BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
-�
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
_
,(
Underground Plbg. Test
_
�j
Final
Gas Piping
_
PLUMBING APPROVALS
Gas Testroo
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gas Piping
Pool Cover
Encapsulation
_
12
Gas Test
Appliances
Final
COMMENTS:
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)
08/16/02 12:22pm P. 002
INFINITY Eb6E WITH f.2" WIDE PAM
WALL, AND :2411 V91DE TROU&H, BASIN
TOBE PE55LF- FIN15H AND HAVE
TINO UPLIC-HT5
I-
POOL
YfiT+i PMEN-E
FINISH
aXTWA SlZnON
POP AitrOMAT(
Ei POOL CLEAN=
+W
DECKIN& BY OTHERS
I
PEGKINO BY OTHERS
6REAT RK
4'--611
08-16-02 12:19 RECEIVED FROM: P-02
MORNINc
ACGE55
08-16-02 12:20
C1ci16il� 1'�:'��prn F•. 11:=:
i
RECEIVED FROM: P-03
j
03/19/02 02:26pm P. 002
+12'
46
®EECKIN& BY C;
6REAT R
- �1a
r'✓ ..�
FOYER
. .m•
.....
101
HIS
(719/19/02 02:2Gpm P. 003
-1
SS%1-7 DQ►V61CITY OF LA uuwTA SUB-coNTRACTOR LIST
JOB ADDRESS __ PERMIT NUlu1EER OWIMEFI ' L BUILDER (�c�NlrJ�-D ods FJI'�
This orm shall be gusted on the jQh with the Build Inspection Carr) at all times In a can .a ouR place. Only persons appearing on NO 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. Fai urn wlll re It in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be tom leted by applicant. "On File' is not an eCC able re onse.
aTrede i Ciassiff.don Connastn► etaft Goat move's Siesrrs orkeri ere■n■H n rnsuranew n.. w...L.w,. t r.-....
Compenv Narrre
Classilieatim.
le.g. A. B. C -a)
Uowse Numbs I Exp. Date
l■xxxxxl I Ixxbrxlxxl
Carrier Name
le. g. Stale Fund, CalCamp)
PoYCy munam
IFornnat Variesl
Exp. Dote
Ixxixxix
License Numbet
o mxxl
Exp. Dote
Ixxixxhx)
EARTHWORK IC -121
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FRAMING (C 61
eTRUCT. 6112L Ic-61)
C--p•�o uf4rre
C - f
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(Po(010(01�
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MASONRY IC -29)
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PLUMBING(C-36)
LI 03
LATH. PLASYM IC -351
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DRYWALL IC -0) _
HVAC IC•201
UECTRCAL IC -110)
ROOFING IC39l
6HFleT PETAL IC431
GLAZING; IC -171
t MULATION IC -21
SEWAGE OISP. (C-42)
PaIN1tNO la3a)
CERNI6C TL! IC -541
CABINETS IC -G)
FENCING IC•13)
LANDSCAPING IC -271
I
POOL IG63)