0206-021 (RPL)44520 Marguerite Ct
0206-021
9991
LICENSED CONTRACTOR DECLARATION
I hereby 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.
License # Lic. ClassExp. Date
k* 1807 C53 WC AA <
Date "">` Signature of
OWNER-BUILDER'DECLARtATION P,0
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 KKEMPT 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
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 ori his
application. - 01
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 td
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 fort1 inl:ectio ?purposes. "
Signature (Owner/Agent) f:•/ Date c 'D
PERMIT#
BUILDING PERMIT,
DATE VALUATION ` LOT TRACT
JOB SITE
ADDRESS 44 x 20 W A&1l+6.F•iF. -MOT 1 iVd4 Y
APN ..
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Time& 81J'K WFa1;,'1%T
2XWG3ND POO MTD SPAS
44-520 ARGUEP,Y, C°1".
LA Q11INTA ti.A 9,2253
11A,-1vtiD ,=d CA 9221.1
USE OF PERMIT
POOL ANDIOR XPA .
5111 'rr il L HE M 1'LACM PRIOR, TO .
yyl a( Q i G1l++.fy.8 k ytpiy3 ly q,. ?(s yAyd: f}3.1n,4y{Z3'bv.11ERS
,C.[CS: rd . :at: Sey, i I`rR 31O'6fiiRC E iO,4'( ..
P001,.AN y7OA, SPA NANA US
f
ESTMAIRD COST OF CIONSINUarION
MAN C11ACK 1'lG? r $64.35
G`ONS7°R.ur.T'ION F'k18 101-06G418-000 $09.00
3u1ECHANICAL1fL:Z- FOOi., 101.000.421 000 $24M
9 %t;.`°i'E2IC L VFl Z.. --'POOL? OL? 101.000-420-000 $45.01.0
1+LUNIDING FR, .,- pool. 101-000-419-000 S2"1eW
i
WB -"NOTAL t;0,V?, MVi.1'i`" 01+7 AN D %SLANR CMCK
$250.35
LESS MX -PAW RIN3,401
$0.00
LUN 0 6 200Z
ncI 111, TA
CEDEPT
RECEIPT
DATE ° ;
ABY
DAT AL ^^
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
Z
Footings
Main Drain2j.,
Bond Beam
Approval to Cover
Equipment Location
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
Gas Piping
Encapsulation
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:
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CITY OF LA QUINT/
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE 0--
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CITY OF LA QU1NTA SUB -CONTRACTOR UST/) ' l `
JOB ADDRESS - CIkU- Be(sk PERMIT NUMBER OWNER Ni L tt( L Sulmit 1 hlotv l "' -S . Set
Only persons appearing on this list or drew employees are authoAzad to work
on this job. Any changes to this list roust be approved by the Building Division pilar to sommenoement of work. Fe II !Wit In pa of work euldlar the voidance
of buldi Permit. For each a ficable trade. all information r below must be co leted Bcant n File' is not an ecc able relmonse.
Trade J CtaaNfatlo Contraatar Bern Contrae0or'e (neuron" Mir Bu*W" laarrwe
company 1Mame Clanlicatim . License Number Esp. Date Catrin Name Roup Number Esp. Date License Number ED. Date
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PLUMBING (0.461
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NVAC IC -91H `
I CTIMAL IC -101
ROOFING IC4MR
SHEET METAL (C-48)
FLOORING IC 5)
GLAZING 10.171
WMAT10N I"
BBWAW OW.. (0.421
PAINTING (0.38)
CERAIM TLP t0-84)
CANNETs IC• 1)
FENCING IC -131
LALDSCAPM IC -01
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