0307-214 (CARPORT) LICENSED CONTRACTOR DECLARATION PERMIT#
I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT OW74.1V
I— Chapter 9 (commencing'with Section 7000) of Division 3 of the Business and DATE VALUATION a 2> j TRACT �.�.2
t4 UJ Professionals Code,and m License is in full force and effect. ,3'�:§,`�`Ci LOT w•
Y
W License# Lic.Class Exp.Date
or-_ w� ? �: t 0.8 HIC 7�:�1JCR JOB SITE ADDRESS 7u-875 AV)E''MI .M.47,,C'�Y�[tACRC IPI APN GOO-d1.�6!-01 ai
� � -"�� { S )+; . �{ ^^���^ OWNER , CONTRACTOR/DESIGNER/EN (NEER
o Z r .Date Signature of Contractor . — .. w`
p r, !CY ,y4 I 2 C%l:S.t",tJ��:I"1r.,Tjc13,.,1i Cl'.'3.,lN`a
J O OWNER-BUILDER DECLARATION 1516*31TRC'1-01""IT 1r,`.'.[i,'01F 755,4VI Ct xY3�L�! i 11:05 I.0,Qj.Tar.-.= CA 92,;5.4
ILLI W � I hereby affirm under penalty of perjury that I am exempt from the Contractor's L�:C1'f:Twrfi. CIA 921gs:i U14DIE00 CA, 921381114
a
~ License Law for the following reason: 01
Z ( ) 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). USE OF PERMIT r
( ) I, as owner of the property, am exclusively contracting with licensed � ����% w !'C°•t2
contractors to construct the project (Sec. 7044, Business & Professionals „
Code). KE ray 6:wyy lrly t, t vnM 4�. a a ., o. aY•. a a. _ .
LO () I am exempt under Section , B&P.C. for this reason 119DU IS ✓�
EITZ IIU$1T F0,
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N Date Signature of Owner
ON
CA
FL Q WORKER'S COMPENSATION DECLARATION
D ccI hereby affirm under penalty of perjury one of the following declarations:
< p ( ) I have and will maintain a certificate of consent to self-insure for workers'
X.UJ compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q Q) I have and will maintain workers'compensation insurance,as required by
OU Q Section 3700 of the Labor Code, for the performance of the work for which this
0- rn H permit is issued. My,workers' compensation insurance carrier & olicy no. are:
NT Z Carrier Zukh'MtftN19 tPolicy No. W,0367:161 P-00 I i,A,T Y . COW O Y C01i$'7RC7MC,tai
J (This section need not be completed if the permit valuation is for$100.00 or less). CONSTRUCTION F' 1101-000418-000
( ) I certify that in the performance of the work for which this permit is issued, P•LKS 4:Wk;C-K H'I✓:L? �Q!-Gt)0-�• �- Tt .:T3
I shall not employ any person in any manner so as to become subject to the ELECTRICAL VE
workers' compensation laws of California, and agree that if I should become STRONO X10TI N yfitl�,T-!'zR;4.r, $3.0
subject to the workers'compensation provisions of Section 3700 of the Labor OUADYN0FEZ 1C!�� tC�J^4�iS-UCG X4$,00
Code, I shall forthwith comply with those provisions.
Date-'-:,,\i}i 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 MUS-IO?`.&L a:Iyz:3l UC'fT.ON AWD PTAN CF? Cis f it`.t,;d
whose request and for whose benefit work is performed under or pursuant to Tait s .1:T't3 FI%s ;.:�,r +
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. T0TA :PFRJJ-°TH.'S,FEE'..;10 SR N.0W' 4
2.Any permit issued as a result of this application becomes null and void if I
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. _
' C ` i IIIIIIIIIIIIIIIIIIIIIIIII 61
I certify that I have read this application and state that the above information is 1 /r,, 1
• correct. I agree to comply with all City, and State laws relating to the building u
construction, and hereby authorize representatives of this City to enter upon 1• IE
the above-mentioned property for inspection purposes.
t
RECEIPT ! "+s` r DATE BY DAT FINALED INSPECTOR
Signature (Owner/Agent) -1 Date 0�.,A
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 6l
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 / — POOLS - SPAS
BLOCKWALL APPROVALS steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Pibg.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
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)