0307-219 (CARPORT) LICENSED CONTRACTOR DECLARATION PERMIT#
U) I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION Lor 285 TRACT 7,4230
w Professionals Code,and my License is in full force and effect.
p =) M License# Lic.Class Exp.Date
JOB SITE
I--
d r !3 E 11 C1-£t lie, /1%3 ADDRESS 18-15.f5,AYKRGE 4 7,V�'.�!'!:rj'Y Z APN f4-1!,-U 01 ra
Z Date j �D `� Signature of Contractor OWNER CONTRACTOR/DESIGNER/ENNEER
�p OWNER-BUILDER DECLARATION _ w., , i, .� � ,
--I O s 1 h BUR �.�rrr � d V-40} �1c��x�� 111 1 ;�)A Q�. X A fi;A X24
LU W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ;"�,.y
U) License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wages as their sole '. '1 ')�:97�4:i5 ( 361V
compensation, will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed 0KRACH r,,^R C4;x,j,(7P'{'
contractors to construct the project (Sec. 7044, Business & Professionals
Code). 1ydo o.F.3:f11:: Kt.r;J:;Y'.>> ttJ),is 9, 1s.1.t,A :r. 'a irFE V!v GL;IR aikL.
co () I am exempt under Section B&P.C.for this reason
LO
N Date Signature of Owner
ON
C)
Q WORKER'S COMPENSATION DECLARATION
0 Q � I hereby affirm under penalty of perjury one of the following declarations: 0MAJ3P11:±.,n,;.'�,g+3�;ET 1,� ,4�)SP
U-) FZ O ( ) 1 have and will maintain a certificate of consent to self-insure for workers'
X w compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q () (y) I have and will maintain workers'compensation insurance,as required by
O U Q S'6tion 3700 of the Labor Code, for the performance of the work for which this
a rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Carver atrtezdC4ti Policy No. WC3MO1_48 EMM411191)E;1;?ST OF
c�D O P:txM4UT TA: a. !'111vRY
Q (This section need not be completed if the permit valuation is for$100.00 or less). CO1,111RUCTION MIX 10'1-=,'-4-J IS-OCU) � `j•
J ( ) I certify that in the performance of the work for which this permit is issued, K.iAN', +'~9•i'FCK FEZ 101-C'(�'�-4as••318
I shall not employ any person in any manner so as to become subject to the M,CTI R;fr,A?,FZZ '101-00e -4201.0(X) WAD "
workers' compensation laws of California, and agree that if I should become F1MA40 Mt T1G14 ri7 L-t?SID 107-00U241- 0
subject to the workers'compensation provisions of Section 3700 of the Labor O �,fh7 )� � 'D�•0 ">'lti �OfJiT .bS. 0
Code, .
Ishal forthwith comply with.those provisions. _•_�
Date:i t`•7 Applicant L Y. _. ... .�. .
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 Sf3BIWP,,CON N91 K,UCV!,00 AM,PL.W CH W!K, �'s�?'i�..<5
whose request and for whose benefit work is performed under or pursuant to I&M PM-PATD.H;: S $Q 00
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 CKFAL 11aYI"C,;'rT ITYE718 DU NOW "'��•
work Is not commenced within 180 days from date of issuance of such J
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 r I IIIIIIIIIIII IIIIIIIIIIII 66
correct. I agree to comply with all City, and State laws relating to the building ,.
construction, and hereby authorize representatives of this City to enter upon - - ._f. IE
the above-mentioned property for inspection purposes. =•
RECEIPT DATE BY DATE FINALED INSPECTO
c '
'Signature (Owner/Agent)_--•----- �'— Date t tf r r r. J -- _
,�,
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 POOLS - SPAS
BLOCKWALL APPROV LS Steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Plbg.Test
Final Gas Piping
PLUMBING APPROVA S 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
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)