0106-140 (RER)LICENSED CONTRACTOR DECLARATION
I hereby 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
Professionals Code, and my License is in full force and effect.
License # j Lic. Class •Exp..Date
BE . Fre
Date Signature of ContractorA• -..-T•^'
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 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 ,ball not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that ii',I should become
subject to the workers' compensation provls,ons of Section 3700 of the Labor
Code, I s all forthwith compyrw those• rov Bions
C-,.Faiture-to,secure-
�VI/dgi WpprkNersleompe ' aYioy� coverage is unlawful and
shall subject an employer to liminal 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
for a permit subject to the conditions and restrictions set forth s
application.
1. Each person upon whose behalf this application is made & each pe on t
whose request and for whose benefit work is performed under or pursnt C
any permit issued as a result of this applicaton agrees to, & shall, ind mnify
& hold harmless the City of La Quinta, its officers, agents and empl
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 lawsrelating to the building
construction, and hereby authorize represe'Ktatives,,oVhis City to enter upon
the above-mentioned prope�y fo 'rispect purposes. '
Signature (Owner/Agent) f Date
BUILDING PERMIT PERM T#
DATE VALUATION LOT 006-140 TRACT
g' (e,{'/ J�/p•
JOB SITE
APN
ADDRESS
'54-949 WMIMA
17:5-1.X'")23
OWNER
CONTRACTOR / DESIGNER / ENGINEER
'E17WA PZ & JOYCE, HAAW,
BR..lal0N M.ME3',.O:fa119%'��,t'
LA. Q1'.ill`1`.I A CA 92253
i..�,.w' CA 92210
RU++0p
?�+1"�y
-
}++1
( 4 -5475 7 M1101
7 3
USE OF PERMIT
M:M011)EIJAr IT ION 0P 617 Sd+'
PER! OP1E.G`QD PLANS, ONLY
CUISTOM (,'ONS z RUCT1O14 617,00 sF
CWtAQVICARPi:iV ".70 Sir
]VIRM"'TED COST OF Cowd-rRUCTIOR
;i'';9s;{ADD! f FKh' SOM7��'.r:4RY
PIAN CHECK ITS 101 -MO -Q19-318 $265,20
COAL a'kRUCT1014 P92 101-000-418-000 $02,00
MIX114A"A€IVIALFEE 101-300-421.000 $191"
Le`.LXO'1'RIC..A.1, FER 101-000-42.0-006 $360
'Llll it C 1 Y ! O1-t�0h„a119.0i30 $.57.00
�d
S�'ftt�,�'1',4 lf102d MZ:,0131f) lv 131f) 101 -000 -?d:-000 $4.89
t�l�e.�rl�t'Eds3 �* .a 1 n i •t'IOtJ��i2:�=4L7fi �;10,0d
•
UG 13 2002
ITY OF LA fllllNTEf ° 1,1.'x) C.'`C;1M�".�UC� j;.�tJX .1UA01�LAM C'•-111:.4,1”
FINANCE DEPT. T USS FRE -PAID FFM,
$0.00
I MAL rERM `-' "ZN Dom: NOW
S8.11.18
RECEIPT
DATE �t
BY
DATE FINALEO
INSPECTOR ri't•
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE —T
.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 I I
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
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
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: