9703-0305 (CSCS)46600 Adams Street
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LICENSED CONTRACTOR DECLARATION
I h8reby 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 # t . Lic. Class Exp. Date
:!f 1057 D - 11/2.19
Date 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 is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
cbrltractors to construct the project (Sec. 7044, Business & Professionals
Code). moi
(r) 1 am exempt under Section B&P.C. for Pais/reason
Date A - l' 7 Signature of Owner ,.>
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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 fof which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier ` { Policy No. R /
t_4(t.j.iM"3T/ SifIN'JNSf ~y""N 1012"41.,W;
(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 s all 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
abject to the workers' compensation provis hof Section 3700 of the Labor
Code, I shall forthwith comply with thosee rovlslons. .
Date:4'-4/_ - ; 2 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 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
co struction, and hereby authorize representatives of this City to enter upon
t 6 above-mentioned property for inns t'or• purposes.
Si nature Owner/A en6t _," 5- ,' , f pate
BUILDING PERMIT i PERMIT# CONTROL#
5892
DATE VALUATION %11:15.857.00 LOT ; W TRACT
JOB SITET
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APN 649411111114101
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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USE OF PERMIT
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RECEIPT
DATE
BY /
DAT
INSPECTOR
NA
t
- 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 Z
F.A.U.
Framing 2 _
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 Yj
Final
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 I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shqwer Pans
O.K for Finish Plaster
(S2!_5! Lateral
Pool Cover
r Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) 2/
ELECTRICAL APPROVALS
Temp. -Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles e
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility. Notice (Perm) G ,
COMMENTS:
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CITY OF LA QUINTA
G` °sof `� lFffi1DING & SAFETY DEPARTMENT
SF Q 777-7012
.ECTION REQUEST LINE
G� 777-7153
F\NP
Owner THE WILLIAM WARREN GROUP
Contractor
HEDLEY BUILDERS INC
Permit Number 9703-105
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 46-600 ADAMS STREET
LA QUINTA SELF -STORAGE
MANAGER / OFFICE BUILDING
IAD L �' � ' I-)
ccs t' ti ► ASF. 3
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL AAOVk HAS BEEIA SWNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC y
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF lz
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' • ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOV9 H S BEEN S GNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FENCE &GATE
EWER SEPTIC TANK /
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
H EATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING