0307-221 (CARPORT) LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
U) I hereby affirm under penalty of perjury that I am licensed under provisions of ii�f�7.1?1
I— Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION r
(n x..�,: i k E LOT 2RS TRACT 24 Klf0
N w Professionals Code,and my License is in full force and effect.
License# Lic.Class Exp.Date "1
r d 184531 A C..s3 F3 7/31/03 ADDREJOB SS 7F�75 A'�I4�1L�47,C:.411r4ifJ1W:4t t APN te�l3•-M411.4
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r- Wc 1 F • sR.075
6 Z Date ! L� Signature of Contractor'' - - �� OWNER CONTRACTOR/DESIGNER/EN INEER
coo O o 0CPH lZro .-f+r.1k•:wrtu:""1io ca,We
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F- ip OWNER-BUILDER DECLARATION r 1 t ,. ,. �,,� •,
--r U r 51(yTAIR( -E ! :f�iUN7 78•4(fI KTIC.;3:tA�s ;.t 4„ f A Q';t41"Ati 9115.
W w I hereby affirm under penalty of perjury that I am exempt from the Contractor's LA�3U1Jt A f_;+y yt f3 i.i;1fi;C40 .,A
~ U) License Law for the following reason: C.'
Mg( ) I, as owner of the property, or my employees with wages as their sole (619.'21V7-1156 t. ' g 360 j
compensation, will do the work, and the structure is not intended or offered for , e Kii7
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed CiARACE OR.C RPOR7
contractors to construct the project (Sec. 7044, Business & Professionals
Code). y6A 4.11'. Q"..2't3' U ('.5 rr Al, Z V;4 t:iJlb.�t f
co () I am exempt under Section , B&P.C.for this reason
LO
N Date Signature of Owner
OC\J
FL Q WORKER'S COMPENSATION DECLARATION
C:) cc I hereby affirm under penalty of perjury one of the following declarations: 0ARA.0 Y/CA1tPORT
Lo H 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
O J Q performance of the work for which this permit is issued.
M iQ I have and will maintain workers'compensation insurance, as required by
O U Q Section 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:
t Z Carrier stVien iVXACAn Policy No. XlYMADW CCILM OF C01160'RUi''D014
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(This section need not be completed if the permit valuation is for$100.00 or less). CON13TRUCTIOP ME 101-Ofw"+_418-OCK) $207.00
( ) I certify that in the performance of the work for which this permit is issued, PLAN CHM"r, P'E9 lot-CM-439-31d $156.79
1 shall not employ any person in any manner so as to become subject to the K.S(.T1t1C./ L FU. 101.0(').420.000 SM176
`workers' compensation laws of California, and agree that if I should become STFCEN(Y MO'."ION?FX•RESIL) 101-t10)-241-000 x3.94
subject to the workers'compensation provisions of Section 3700 of the Labor OKADl ,t3 Y '2 143 0 + x 3-f7tfa Sl�i.;►U
161 Code, I shall forthwith comply with those provisions.
Date: -N s c, `� Applicant -
.�' f f
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 f3f3-TOTAI.C0N;3:"Kf.sk7T*.,() l AVIV,PUAT
whose request and for whose benefit work is performed under or pursuant to �i--•� 1,„ PIM-FAID Fl3F,m (j rfO
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. ///! TOTALS lvlri4'WT,fc1715 WE NOW
4cf-
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 J 0 1 2��3
permit, or cessation of work for 180 days will subject permit to cancellation. UJ U
1 certify that I have read this application and state that the above information is CITY Of IIIIIIIIIIIIIIIIIIIIIIIII 68
correct. I agree to comply with all City, and State laws relating to the building 4�J:VTA
9 PY Y 9 9 Flf�",1"C@ CcnT
construction, and hereby authorize representatives of this City to enter upon IE
the above-mentioned property for inspection purposes. ,
RECEIPT DATE BY DATE FINALED INSPECTO
Signature (Owner/Agent)•-_ �-" Date �`" ,mss ` ' z
�r J
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms 8 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 APPROVALS Steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Plbg.Test
Final I 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
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)