0108-099 (GUARD HOUSE - PALMILLA) LICENSED CONTRACTOR DECLARATION PERMIT#
U) . I hereby affirm under penalty of perjury that I am licensed under provisions of UILDING PERMIT
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE r VALUATION LOT lfJ, 4�e$_4Y TRACT
C14 to UJ Professionals Code,and m License is in full force and effect. v
O c� License# Lic.Class Exp.Date t� Q, t.�j
LO JOB SITE APN
i � ,� ADDRESS
W i Qi�P&1e°� 11 MC A �%r^���• ' OI�.L i°�`••�'a@9.+I���'�.t�9 AK`�) �7:Z�Z�iT�t37
Z 'r'--
Date Signature of ContractorY_ '" OWNER CONTRACTOR/DESIGNER/EN (NEER
�r�.0 �t _OWNER-BUILDER DECLARATION :s ¢3k (°' 5 'S ig 'r3 +.� ;;a,Tta�".
H LU I herebyaffirm under enalt of perjury that I am exempt from the Contractor's *r
penalty P 1 ry P PQ BOX 810 1425 Z•t NINI'14:f�r11T LMVE
co License Law for the following reason: QUTWA CA 92,233 AZ 85034
Z ( ) 1, 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 (Ga nv51"1•x'56 CUR 4'9903
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Co)W. ,AE-tc;T L
Code).
LID () I am exempt under Section , B&P.C.for this reason RA1.,1MH.11.GUA.RD'��x'4.3USE(256 S.F. IGLUS N)l S.F. CANOPY)
(\I Date Signature of Owner
0.C\I
d Q WORKER'S COMPENSATION DECLARATION
CD cr I hereby affirm under penalty of perjury one of the following declarations:
i r H 0 O 1 have and will maintain a certificate of consent to self-insure for workers' Pt>RCHIPAT10 $02,00 MF
X W = compensation, as provided for by Section 3700 of the Labor Code, for the ��C COMMERCIAL 2156.00 Sl:
O � JQ performance of the work for which this permit is issued. �fC..'R.Pl,�:�AMOUNT 14 2154 SF
m Q U I have and will maintain workers'compensation insurance, as required by ` '
WN
O C) Q S ction 3700 of the Labor Code, for`tfie performance of the work for which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Carrier Policy No.
ob d �t�"AU FUND .103906-00 UMM_ COST OF(7102 ,'s. �1'C`,'�'dO.l'+T 711.1627.E
Q (This section need not'6e completed if the permit valuation is for$100.00 or less). PERAW•MT I"y
_J I �t�•NI�`.f3,Zrl�'':i'ION''SE '101-000-418-000 ;iloo
( ) certify that in the performance of the work for which this permit is issued, ..V
I shall not employ any person in any manner so as to become subject to the P1..lN g HU11K FEE 101-.000.4.39-a 3 R $314.16
workers' compensation laws of California, and agree th��should become MEXHANIC,A.1 FFR 3,01-000.4.21-0300 $39.50
3 subject to the workers'compensation provisl uts of Seetlon 3700 of the Labor ,
Code, I shI for3hwith comply with those prb io .Lit I ,IVE
Date: Appliearit �.•�''"� 1'x:+1 1.81,"14 E 101-,-0 0.4.19-0Ui1 $0,0
S'Roklo Norow RBI•colk d; A 1101 cto-u�1-000 $4.!a.
Warning:-Failure to secure Worker_F! ompensation coverage is unlawful and fiJf° RMi !?13 IMPACT PER
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 .d1.Y•?.!IN Y'9UB'LIC P3.ACIS`3CUM)701..0UV;-`a:UUU �
of the Labor Code,interest and attorney's fees. o
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 1 7 21101
application. AUG /
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 t_��t�y �`:� :► ECtfi(�;<�<J {gyp �y�.( €IIF LA CU NTA
any permit issued as a result of this applicaton agrees to, &shall, indemnify I� _ I $f 00
& hold harmless the City of La Quinta, its officers, agents and employees. m
2.Any permit issued as a result of this application becomes null and void if =
work is not commenced within 180 days from date of issuance of such -rm-AL 'Smrr Fus 1t'� TeNk91$+°
permit, or cessation of work for 180 days will subject permit to cancellation. r i
I certify that I have read this application and state that the above information is III�IIIIIIIIIIIIIIIIIIIII 36 i
• correct. I agree to comply with.all City, and State laws relating to the building
construction, and hereby authorize reprewntativesoof this City to enter upon L_.' IE
the above-mentioned property for in pe ion oses.
RECEIPT DAT,E.�f BY D, INALED INSP C R
Signature (Owner/Agent) `�^' Date +'� •�+'� 'f �'P `���
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROV LS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms&Footings Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck .�L/�Q� Exhaust Fans
'�. O.K.to Wrap =�/ O( F.A.U. -- —
Framing �G—�2_ �� Compressor
Insulation lU l�y—Q Vents
Fireplace P.L. Grills
Firepla T.O. (/ Fans&Controls
Party Wall Insulation _ Condensate Lines
Party Wall Firewall
Exterior Lath U d
Drywall-Int. Lath
Final
Final �P� .t 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 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 Ca
Sub Panels �t
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp.Use of Power
Final _
Utility Notice(Perm)