0305-050 (BLCK) LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
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 DATE VALUATION LOT TRACT
PUProfessionals Code,and my License is in full force and effect. =� � -1st )
ON o`-, �scense# Lic.Class Exp.Date
r- d uf• „ iy y r JOB SITE +. ,� APN
41M92 92 C'8 C:.9 KJ I AV4 ADDRESS 7��ts„Z.AC1?!� 1�:,�s• � :'� �r I�AICtf:`I
Z r� Date Signature of Contractor OWNER CONTRACTOR/DESIGNER/EN (NEER
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CSD — O MiW'.i4.�iOMM1f ���1°Xi �:.it1.:.�'S0';\TZ�,ZY�r
OWNER-BUILDER DECLARATION
_J U r- 81-2 4fl Asir"r1X;E 6 Al 10471 W,t"ROV?X.T. 11TUM.S .
W aW I hereby affirm under penalty of perjury that I am exempt from the Contractor's L tZ m�-c.Auk 92Z O Aa u ,A 9 29x i
Cl) License Law for the following reason:
Z_ ( ) I, as owner of the property, or my employees with wages as their sole C114)2FI.0212 062 1
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 C$,�'•T';,pL T3U31X,L,4-',1
contractors to construct the project (Sec. 7044, Business & Professionals
Code). r- dll4t+4K.h'iY€14CiYL:4 !4VALA.y C Ki;r%.:?rur:i:M, r.r.N l:uw. cJt.V.
M O I am exemp},,under Section B&PiC.lfor4this reason + APE'I� IE1,i A-1.1 i
0
O �fDate Signature of Owner
Q WORKER'S COMPENSATION DECLARATION
Lo C:)
cc hereby affirm under penalty of perjury one of the following decl rations: 4I'll. ��L, 8,�4L'.D 'OFFZ p ( ) 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 � Q performance of the work for which this permit is issued.
C0 Q L) ( ) 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
IlLOF- permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier CLARYFND N NAT,3i Policy No. v11,RGmm X 3;e'Q2N4'REV)£:Ogr OF CS.+MsMITAMON 2"131gjP.W
irD a MRK0. Jfl.'ld 8fif.1r'k,a=atfti s,
J (This section need not be completed if the permit valuation is for$100.00 or less). G0!'l9TRIXT"Ov1 �',- TUT_01.10-41 F-Ko
( ) 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
3 subject to the workers'compensation provisions of,Section 3700 of the Labor
Code, I shall forthwith comply witht those provvisio+nsA,, 1
�-6ate: r1; '' i Applicant /\
[
Warning: Failure to secure Workers'Compensation coverage is unlawful and D
shall subject an employer to criminal penalties and civil fines up to$100,000,in MAY U 5 2003
addition*to the cost of compensation,damages as provided for in Section 3706
of the Labor Code,interest and attorney's fees.
LIN OF LA QUINTA;
IMPORTANT Application is hereby made to the Director of Building and Safety FINANCE DEPT.
for a permit subject to the conditions and restrictions set forth on his .
application.
.1.
1.Each person upon whose behalf this application is made&each person at n'.ill-P. IV,rM i s'°T'R'.1=1 1_1� MD PrLpa`i:"}s'A''.L, �+ � so
whose request and for whose benefit work is performed under or pursuant to 's, L."611 F1,111-J)i'm 7+'r;, 0,00
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 ' � ' 'W111.NOW
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 IIIIIII VIII III VIII IIII
1 certify that I have read this application and state that the above information is 33
• correct. I agree to comply with all City, and State laws relating to the building IE
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for nspection purposes.
Z- RECEIPT DAT , . BY DATE IONA ED INSPE R
L D
� ,Signature (Owner/Agent) Date '"
` w
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
OX 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 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) �� 41j
ELECTRICAL APPROVALS
Temp.Power.Pole
Underground Conduit
Rough WiringLow Voltage Wiring� `,6„�/�7—J4 ;;7�3
Fixtures - � "'^/Main Service
Sub Panels.
Exterior Receptacles 7/�e13
G.F.I.
Smoke Detectors
Temp.Use of Power
Final
Utility Notice(Perm)
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s CITYOF LA QUINT►A
�
OF
�.�130ILDING &SAFETY DEPARTMENT
lk 777-7012
• PECTION REQUEST LINE
is i4�.' a 777-7153
Owner,, SHEA HOMES
y
contractor- PACIFIC MASONRY
Permit Number 0305-050
- POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 81-262 AVENUE 62
8,940 L.F. 6' GARDEN WALL, ORCO SYSTEM,
PER COM. DEV. APPROVED PLANS
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING/WASTE
j U/G ELECTRICAL/GROUNDING
FOOTINGS/STEEL
i CONCRETE SLAB
! DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL/PRE-ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
i
I
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
i GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION,
SEPTIC/GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS/STEEL
BOND BEAM
POOL/SPA/WATER FEATURE INSPECTIONS
PRE-GUNITE/SETBACKS
U/G PLUMBING
U/G dAS
U/G ELECTRICAL
CPRE-PLASTER ALARMS/BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL/JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
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