9811-018 (AR)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. Class Exp. Date
6i3/.s57 li i %� {� ��litNi
VDate -- 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:
( ) 1, 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.
ST ATS F 113 R1D 'l^9-9211-0(itlJ S
(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, apd agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
06de, I shall.forthwith comply with those,prow1 isions.
✓Date: t / Applicant—
Warning:
pplicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. , g
1. Each person upon whose behalf this application is made & each person°at '
whose request and for whose benefit work is performed under or pursuarifto
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
Correct. • I'agree to comply with all City, and State laws relating to the building
construction, and hereby authorize, representatives of this City to enter up
the/above-mentioned property for inspon
ection' purposes. ( a
"Signature (Owner/Agent) '' t `t t%r• ~ Date
PERMIT # CONTROL #
BUILDING PERMIT
,.#,_�
y
DATE VALUATION �"�`4,4" 8() LOT TRACT Q
lIS (% 1 V
JOB SITE r /
:56,345 RIVIERA
APN — -
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
WALTU. CHARLES & NAN RKNSE.T.
BOB E*TD% f.,1k ti' DS CONSIT'RUCl'1ON,
56,343 RIVIERA
79-920 FIESTA DRIVE
LA QUINTA CA, 9� ,,'S"
LA QUINTA CA, 92253
('760)715-793- 0.131..#1 3212
USE OF PERMIT
US11.>E1v-'iIAL ADDIF ION
GOLF CART GA.Re'LOF,
Gr1:12A��JCr�12:FC3i�.".i' ti?.$.f}i1 aF
UST1;AI x.',ZD COST OF C'flr1X1: RUC i ION
4, 4IA. 30
41,Ci RMIT FrUt Si1MMXRV'
KAN C101CK 1.11% 101-X439-318 $46.80
5T TTC.'r!O-N FEE 11(91 -non -419)) 4??.40A
K
.
)f-'f?N
1:.1-1.1X7 111CAI, til. t 101-000-420-000 317156
STRONc'3 MOTION FEE: •1;t2 iSTO 101-000-241-600 x;.50
i
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C ,)N',KYRU(; T10N ANT? :PT,AN CHIRICK
X138 86
LESS PRE,-N.YDIC
FEff
K IM
3i 1'Ail PERMIT 1;+ ;, S� .11)81: 1*1C9NN'
P4p
8.38.86
NOV 12.1998
�
rECEI r-
BY
D vT 5� rt `ep ����
i
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS ti
MECHANICAL APPROVALS
Set Backs
- Underground Ducts
Forms & Footings
Ducts'
Slab Grade
Return Air
Steel.
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap _ r,
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
BLOCKWALL APPROVALS
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
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
� y
r
Final
UN4 Notice (Perm)