0309-041 (SFD)79700 Amalfi Dr
0309-041
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
,Date i i : ► - Signature of Contractor"'A 1
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 afn exempt under Section , B&P.C. for this reason
Date Signature of Owner
i"
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
Segion 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:
Cartier 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 shall 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
subject to the workers'.compensation provisions of Section 3700 'the Labor
Code, I shall forthwith comply with those provisions,
gate: + s 1 APPlicant a !
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,coriiply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) !\ s+-- -w ' T Date i s . yr
1 t —
BUILDING PERMIT PERMIT#
DATE VALUATION LOT }";t3j- Y TRACT
pI. , +p n
%/rti % A H'•%CQ •r"7 ..111 0 6.rL•+.v 6'. ^
JOB SITE
APN
ADDRESS
79-.'KAI A "I DRIVE
OWNER CONTRACTOR / DESIGNER / EN (NEER
PONDIMOGAWAAYS, B,11^TC. PCJND"Fk0SAIM-WS, LINO
64.1 j 1 OWZ'G .3 T R.MV, 400 R FARTMIL "DR ;SWM : • l C3
CA! 94.588 CA 91Lf
(703)18.1 -7 10 73116
USE OF PERMIT
'
$Jsdll3 . 1r i 'JI." P l Xc. ., 11
+
I IIIIIII VIII III VIII IIII 32
. L ' 11; P1 A:0 3A,3.L PUK-11T DOES NOT, INCL ODItT Ff1. :3E 'n I IE
S7TD
QYl1.AJYviS%, P rOC,)4 9Pt ORl DRI'%I :1 AY l4}-'[ ROAC13 - .- ---- -----
T13A!J COINS RUt',3!0W 31033.00 SF
iORCHPA10:0 500.00 SP
0ravMUCEaRT Sp
:. r '•E1 '"!91) COST OF C1 € S"" ' s n" O N
].85,.x-71fil"
ye,
y i •t SUMMARY
CONSTRUCTION RE ) 0) _000-7•1 5-0100 $901301
FLAN CHECK. EEE M.30
MECHANICAL M 1.01 -?100.4 1- 00-') 481150
itZLECTRICAL FEEL 101 : ,'.30-!ts"ot/-CDS
?TR0N t4fw% T IOht f_*S * RES10 101.000 -241 -QW 413.58
ORAUNG RE' 1-01-000-423-:000 VS.%
D1"lp'L+-1„OPEX 11d1L° IV,' r t?.??
P. .! 3 C ti 1 :
,mak •.116
OCT 2 2 2003
LA QUINTA
RECEI T FIN p,QE DEP
By
DA INALEWI
ECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings A 1W,
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
_
O.K. to Wrap
.U.
h Al
Framing
Compressor
_
Insulation
Vents
d
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
'
Final
'
Final ✓d
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 PWVA
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out -
Equipment Enclosure
Shower Pans
OX 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
Final
Utility Notice (Perm) .