0307-0357 (WALL)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
'701f339 _)3-M.0._ (__0 1f2t
Date _f�e!� Signature of Contractor c, �
WILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractdr's
License Law for the following reason: `�`' •. _,,; yrr
( ) 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 tho 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 S ATE FUND Policy No. 000.1648013-03
(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, and agree -that` I should become
subject to the workers' compensation provisions ofNSection 3700 of the Labor
.Code, I shall forthwith complywith'those grovls&on-45
.
Date:-r-;i:?ADDlicant `
Warning `Failure to secure Workers' Compensailon coverdge"lis unlawful and --
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, da ages -as provided for in,Section 3706
of the Labor Code, interest and attorney'-�ees.
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.
V'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, indemnity
& 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, f this City to enter upon
the above-mentioned property;#or inspection -purposes.-- -
Signature `(Owner/Agent)
,1
BUILDING PERMIT PERMIT# -
7_35 /
DATE VALUATION00
LOT TRACT
tirl3 P�" i 7 l 30331
JOB SITEewv
APN
ADDRESS i�&OU 742 AAU-RA C07JIFT
_
OWNER
CONTRACTOR / DESIGNER / EN &NEER
I.A Qrt7WA _ TAT AM LW
TRANS WE 87 HOUMNG WC
996 I.11I3 n"a Mum., , ny.v 102
mw 11113.'> , sr mrz 102
SAN 1311 GO CA' 92131
BAN i) EGO CA 92131
(858)6St•3o03 t M4 4972
USE OF PERMIT
01W,: 41'.. W.U.M.�
9$3 LIP 6' OAid,F FN WAII. Al. OU111'IP.k Or P/L AND 43 .LiF 6'
RETAIN R40WALL PER APPROVED PRWISE GRAD1140 PLAW, ALL PER
Z1RCO STANDARD.
4 FT. WALL 1,431.00 LF
Pl TIMAT ED COST OF CONS"IR.1YC"1 00
Maw 8lfMRY
CONSTRUCTION FET, 101.000-419,0100 $25330
JUL 2 9 2003
CITY OF LA QUINTA
FINANCE DEPT.
Wim 'i, GOA1�^.R1�C'°3�0:�'.A1 P'1-: CS IC:
• - .1+.1I I''li.1w x7.11ia k3t7.G{3
IIIIIII VIII III VIII IIII 07
IE
e
-
RECEIPT
DATE
, ✓') 5
BY 4_
DATE FINALED
/ -1
INSPECTOR
(15n
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
—
Main Drain
Bond Beam
_
— — S
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
ELECTRICAL APPROVALS I
Temp. Power Pole I I1
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS;