03-0097 (SFD)54450 Avenida Alvarado
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LICENSED CONTRACTOR DECLARATION
I Hereby affirm under penalty of perjury that 1 am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp.. Date
/634981 13 i) /31120i
D"a e-77
Signature of Contract. '? ‹ e
Y 4lam`
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that 1 am exempt from the Contractor's
License Law for the following reason:
( ) 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
sale (Sec. 7044, Business & Professionals Code).
( ) 1, as owner of the: property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, 'Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
( ) 1 have and will maintain a certificate of consent to self -insure for workers'
• compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. a?e:
Carrier Policy No.
GOWENI t.>`LL 4.3.,, =C41;2860-02
.1,1s..,,o00:
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued, •
I shall not; employ any person in ap.manner so as to become subject to the
workers%'compensation laws of California, and agree that if 1 should become
subject to the workers' compensEtion provisions of Section 3700 of the Labor.. --
Code• I shall forth Ith comply with those provisions.
pati( 7J (') Applicant 7i a f / r
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Warning: Failure to secure Workers' Comp ensat'ion 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 oh his
application. .
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
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
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 certify that I have read this application and state that the above information is
correct.l' agree to comply with all City, and State laws relating to the building
construction, and/hereby authorize representatives of this City to enter upon
the above-mentioned property for inspectionnnsJtipur oses.
Signature (Owner/Agent) r. •-P" 6 f Date/ ' / -
_✓ Cc;!
.' . BUILDING PERMIT PERMIT #
011101-1)97
DATE VALUATION sil14
,239.60 LOT 14 TRACT i3T,1t 265U
- k X10-0
2
JOB SITE
APN
ADDRESS54-4S0 .E .VENIDDA A.LVAR 3
774 -241 -til
OWNER \
-
CONTRACTOR/DESIGNER/ENGINEER
110BI RI & SY:
rAk,T1. LOG
CORONI;1, CON S,' :UC!'.ON
4/783 WA. TRI SiE
3i-340 EiFsi fHOW DR.
!.A QUIN:'A CA 92233
LA. QUINT.A. CA 92253
(y60)564-4604 CRL4 2261
USE OF PERMIT
,_
`IIIIIIIIIIIIIIIIIIIIIIIII
` OL FAMILY FAVY,::LLINO
76
.
,S1 D -PERM.' DOES NOT INCLUDE BLOCK WALLS Oita 001.,
IE _-_ _-- —__
TRACT CONS 1 Waa ,S [ON 1.696.00 SF
OAitAcriIi,ARK)R,%' 5:13.00 3F
f 1"T. wool? FENCE 2110.01, LF
'
ESTIMATED COST OF CO kSTRUC IOC Yr
104;219.60
10ER 311 T Ii'Fi+: SUMMARY
00..):NS'I'R.UC[ low FE1i 101-000-41.8-0O0 s6s7.00
)31,414 0..trirx FEE 101 -EA11{1»43R_31Ft A55;, 57
i •C Cf TA 1CA.L a M 101.01 0.421-000 V3.0
ELEcTR1L AL ► E 101-000-420-000 $t.49.2
PLU.MbNu F1 ' 1.01-000-419-000 $122,75
' `
4 !`ttr'NO 'MOTION PVT - RFsTr) 101-000-2 41-000 $I042
< r yy r f-101-000-423-000 $20 r
{-+I.I .J,.)t .`ary %'tSLS W..V.4i0
Li V.t LO i i R, iMF'AC i; Ffi1.s $1,../.1..10
PRECISE LAN • 101-000-441-345 Sl.ttol*
a:R'r IN Pt 1141,14- Pf.nrrS .13F8)11 701-000-255-000 iin 64)
I L Df O tfr 101-1103-43')-311 . 4250.10
St.JR.."fOTAi. , CC)NS'TR It TI I AND Pi. ANc,:1=7f rIcII:
:Vcsr, {F'i
a
LESS PRE -L a 1. .D FEZ
4:2.50._00
TOTAL Pff;K.M.IT 4' .1i,.S DUE NOW
1,,3.3.36
Ji' r
RECEIPT
DATE
BY '
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR -
BUILDING APPROVALS
MECHANICAL APPROVALS -
Set Backs
t
Underground Ducts
, •
Forms & Footings
cJ
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
, j '9•r > J
Exhaust Fans
O.K. to Wrap
,
4' -"( 6 - p,-- 57
F.A.U.
Framing
if - 06y,,.
Compressor
Insulation
6- 2...-ist, S?
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls .
Party Wall Insulation
Condensate Lines
Party Wall Firewall •
•
ExteriorrywalLath
C
Drywall - Int. Lath "7
7/ 3 1 0 0
! J7-•
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
Gas Piping
�� '
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
0
(ee
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
',?
Pool Cover
Sewer Connection
algl�S
Encapsulation
Gas Piping ,
T C
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)
7/3//6040
11
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