9707-071 (RPL)i U);
N U)
LLJ
O � �
' W
':.
C:)0
z
(0 O
H to
J
,W W
(n
Z '
LICENSED CONTRACTOR DECLARATION
_I,I erAy'affirm under penalty of perjury that.l am licensed under;provisions of
Chapter 9' (commencing with Section 7000) of Division 3 of the: Business and
k@ Jrgte>ionals Code, and my License is in full force and effect.
, ba.;se # Lic. Class % Exp. Date
r..
Date L •K< Signature of Contractor
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 isnot 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).
O 1',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
Sec ion 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.
y ^I .1%.,r`�!. 14`I.P. f'ti i;vt's; t. •"A'f, ,`, 2sp0 is
(This section. need not be completed if the permit valuation is ,for $100.00 or less).
() I certify that in the performance of theeork for which this permit is issued,
, I shall not. employ any person in any manner so as to become subject to the
wo,rers' comPensation laws of California, and agree that if I should become
YY�de',
bject•.to the workers' compensation provisions of Section 3700 of the Labor
I'shall forthwith comply with thoseprovisio 8.
te: 7" 1.k -C ---Applicant—
Warning:
Applicant Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil,fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the LaborrCode, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
_for a permit subject to .the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certifykhat I have read this application and state that the above information is
correr5t. I agree to comply v�'rith all City?and State laws relating to the building
co �tructi��� ra0l, reby abthorizef representatives of *this City to enter upon
t above-mentioned proper y for,inspfecton purposes.
i
,/Signature. (Owner/Agent) ? Date
BUILDINGPERMIT PERMIT# °°Nrl3°`# ,
55 �'
DATE 7(1NP)7 VALUATION SI3,Qi(lfLt)f� LOT TRACT
: 1,51)0 i iY�,iY'I9�r� ��lEir�$�' CON
APN
ADDRESS ,
OWNER
CONTRACTOR / DESIGNER / ENGINEER iY
51.3:((�S��� t�55.pp�.yy1:��111�+.103 \ Q',P 'tEtrf. tJgyp.
Lv{ RiP 'ji'1.
(.IR
l�tf�'1(1��. i'(F�p?i�',f�t• 'k:.+' 1).ya �.i
<lt�l.,l �. �3i. M1l�.)V% t 'tk
USE;OF PERMIT
1�'.,i':.�.(..ti.til,.?'A,`�k:s/•�!'1, ld,��tFJ.�ll,al..}:
•.
cl {' t'0.� 4. A.. 9iJ O
•,µ6q W,fb R. g$ 9-i_'.��jy !'Je •n \.' !.' e J 'f�+('}�J1}t�4�. k f:y.'�1 Y
f.
1 Yet
tl 9Sdi a Cl'RY,} 7d- .
t04 0(0_1 9ti_'�lYi 4+g}, u1j
ttL.f}ih'r
!'l,t,+ fiblfWil f=tst 1' i ll.. i01_C 4_4iv-t K)
a) - -.
OD
1
4 rR )t.
11VAi��l..f l ,,1>;
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
'Set Backs I
Underground Ducts
Forms & Footings
Ducts
Slab Grade 1
Return Air
Steel
Combustion Air `
Roof Deck i
Exhaust Fans
O.K. to Wrap 1
F.A.U.
Framing 1
Compressor
Insulation 1
Vents
Fireplace P.L. }
Grills
Fireplace T.O. i
Fans & Controls
Party Wall Insulation I
Condensate Lines
Party Wail Firewall . I
Exterior Lath i
Drywall - Int. Lath 1
}
Final
Final }
BLOCKWALL APPROVALS
POOLS - SPAS
Steel. -
Set Backs !
Electric Bond
Footings }
Main Drain
Bond Beam I
Approval to Cover
I
Equipment Location
1
Underground Electric
1I
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines 1
Heater Final
Water Piping 1
Plumbing Final
Plumbing Top Out I
Equipment Enclosure
Shower Pans }
O.K for Finish Plaster
Sewer Lateral 1
Pool Cover I
Sewer Connection
Encapsulation
Gas Piping I
Gas Test
'Appliances i
Final
Final
Utility Notice (Gas) i
ELECTRICAL APPROVALS
Temp. Power Pole i
Underground Conduft;
Rough Wiring ]
Low Voltage Wiring
Fixtures 1
Main Service {
Sub Panels r
Exterior Receptacles I
G.F.I. i
Smoke Detectors f
Temp. Use of Power i
� I
Final i
Utility Notice (Perm)
COMMENTS:
/_ „1
%'t �"
N.
/�
k
.. ..
_ _.. . .
...
-..... .._.. �_., .. ._. _,-.....__ ,, _. .. -.. .. ,- - .� _ .f.. _ __
...
.. � y
. ....
- _. - � _
r. ..
...-
..
- � y.
. ,
'.
-. _
.,
_,.. _ � ,.
.. r
.' :. ..
',
,.
.,
_ ,� ...
.. _ .. ..
.. ;;
,'
�.
,.
;.
. ..
,.
a, >� z
..
.. ,� _. r--... -. � .w.,_W...._..,.. ,..,__ ,..,._.