06-0058 (BLCK)54450 Avenida Alvarado
co
(NI w
n c*)
d
oZr--
dor
HBO
J
`
F -a
Z
0
u7
X
0
m
O
d
c)
O C"
U ,
L
d Q
2
I-0
W
J J
U U
UD
Z
t
r0
J
LICENSED CONTRACTOR. DECLARATION
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
Professionals Code, and my License is in full force and effect. •
License #` Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
(J., I, as owner of the property, or my employees with wages as their sole
'&corripensation, will do the work, and the structure is not intended pr offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclu3ively contracting with licensed /
contractors to construct the project (E --)c. 7044, Business &/ Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason.
Date /. <.s I\ 1 Signature of Owner 4.--r1 a• :k + /s
t,t. fi r .
------ '"""""'"'WORKER'S COMPENSATION DECLARATION •
I hereby affirm under penalty of perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for worker/
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. are:
Carrier • Policy No.
•
(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 any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. /
Date• ' - • Applicant ^ '
4+r5 v J 1 moi' r 1 L.,
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.
F•"
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 cf 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. 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
the above-mentioned property for inspection purposes.
• Signature (Owner/Agent) tw r % - r !' r ` Date t4 `,
DATE
BUILDING PERM -1414
VALUATION LOT L.
PERMIT #
0.
Oi45-0TRACT(
JOB SITE
ADDRESS M-450 AVEMDA ALVARADO
APN
OWNER
ICDVACS
54*45O M''VARA,DO
LA.(jTANT's
6.1t. 92253
USE OF PERMIT
LV AL.F AI DB' C3•
CONTRACTOR/DESIGNER/ENGINEER
,- C:TALPt
OW. TER. BUILDER
/0 L? 3' CiARDM WALL
" .;.xv b' OA F,N -WALL Calk STANDARD
6 Ft WALL
5 rr. 'WALL
30.00 LF
16.00 l_'
ESTIMATED COST OF CONSIIIwcnoN
PEIdarr ME SUMMARY
CONSTRUCTION FEL 301.00OE41S- 00 S25.00
'4'--
4
B 3B -Z DTAL CO ATI;.I'i JG 'TON u/ PLAN Cil .CK,'.
LUSS PRE -PAID FEM
g d PERMIT DUE NOW
JUN - 5 2001
96650
$25.010
$0.00
25OO
11111 1111 73
i IE
RECEIPT
CITY OF L"'i iiNrA
FINANce'DECr
DATkFINA 7
INSPE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
Ducts
Forms & Footings
-
Ducts
Slab Grade
Retum Air
SteelCombustion
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
2Z6
5
steel
Electric Bond
Set Backs
Footings
C
"7
Main Drain
Approval to Cover
Location
Underground Electric
Bond Beam
/a//�Jd
GEquipment
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
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
t3