9911-0192 (PATIO)LICENSED CONTRACTOR DECLARATION
I hcviuby 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.
License09r,0 i 0," Z2.
'Exp. Dat�)12N to ' Signature of Contrako
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
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.
(k) 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 nT,A,M 1,,,,N,D Policy No. '17_1-"-0W,
(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 CaPfor'nia, and agree that if I should become
subject to the workers' compensatlo�nrprovisions of Section 3700 of the Labor
Code,.l shal fort comply wit o e visio s.
bate: Applica� �
WarJning: 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�Ath all City, and State laws relating to the building
construction, and herebyjauthorize representatives of this City to enter upon
the above-mentioned prop�derty for inspectiaffpurposes. ` �^
Signature (Owner/ ger": r1/��9+wt�Date! r�T'/fir
BUILDING PERMIT PERMIT#
DATE 11/29/199VALUATION 57,926.89 LOT TRACT
JOB SITE 43-616 ALBA (:#2I i
APN
ADDRESS
FlNER
CONTRACTOR / DESIGNER / ENGINEER
t8r-tl �rt SAAtrlC)D
4♦ +� xrt•u tw
Cr Wt AU4n lt'�'r{t1l:�r A Allrt�rING C
..w/art. t v t.t.tr ts, �� ,v tvwl C�.
43-o16 ALBA COM
46GS0 C ML11OUN S-rikEFr
LA QUINTA CA 92253
Ii D10 (-'A 92201
USE OF PERMIT
PI HO
1:r St•- tiLUNLA.Wr _sOUVA1tO t)VI+Y, tt_60162W,
PORC PATTTO
1=1111ATED CWT OF CONSTRUCTION
lrEiiRlUT %h:E.'trtJNtAir4i21'
PLAN C HFCK h'I.ili $64.33
(T0NgTRtt'C"•1'40NfT°R ii)t d)i}!) 41fS-(1!}!} $`>�'ta (►t►
;MON0110'T:ONM3. RESID I01 -OW -2.11-000 $ 71)
ti.JP1=1Y33'A1.('0N1R1'FtL.1('rK)N ANI) PI -AN O ETEC K
'�:Ifi.l itt
LESS FRE -PAM FITS
50.00
TOTAL MIRMi•T Fit•:M DMINOW
si".t.e
� I
IIIIIII VIII III VIII IIII 70
�
Y
RECEIPT
DATE
BY�
DAT�ND
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 Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
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
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:
SITE PLAN
NAME- --PHONE
SITUS ADDRESS
ASSESSORS PARCEL NO.
Provide North Arrow
REAR PROPERTY LINE
74
I -
"o
1,3
P
R
0
P
E
R
T
Y
46080 CALHOUN ST,
INDIO, CA 92201
3474592 FAX- (760). 775-5434
s
D
E_
P
R
0
P
E
R
T
Y
46080 CALHOUN ST,
INDIO, CA 92201
3474592 FAX- (760). 775-5434
kl
. NZ
OUT
3HI
No ION 3HV G.t of
03AOHdJV 3HI
80A
k3
I
11-0 r__ N,
rl n
d3 il n
I
MENA
t 2 Vivo In clgD 'v
: Dt#�C�t. Dt
i'��t�D t� 1NF �bbl+Q/I�D
UE-M2bECIs4g tri: DL 30
D'd.L r
k DEbf
1W iv