03-0057 (BLCK)54470 Avenida Alvarado
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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
634951 • 1i \. 01.,.E/20(
Date "' Signature of Contractor•
! c' G
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, 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).
( ) I, 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'SCOMPENSATION 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 workers'
compensation, as provided for by Section 3700 of the 'Labor Code, for the
performance of the work for which this permit is issued.
(7)'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:
Canier - Policy No.
ST TE ruP.17
.1542.937-00.
(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 tothe workers' compensation provisions of Section 3700 f the Labor
Code shall -f rthwith comply witfkthose provisions
pYte 5 OI-Pplicant i i'" 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. .
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. I agree to comply with all City, and State laws relating to the building
constAuction, and herrebyyauthorize representatives of this City to enter upon
the Bove-mentioned.property for inspection/p(urposes.
signature (Owner/Agent),A { Date ) --
DATE
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' /{ BUILDING PERMIT PERMIT"
VALUATION LOT4.14)(1,-4)57 (5a4)5, TRACT .
2S 1,032.50
JOB SITE'
APN
ADDRESS`34_47O 2,LvAILADO
- -
.OWNER------
CONTRACTOR / DESIGNER / ENGINEER
RIM KEr r r • x
CORONEL CONSTRUCTION •'
• 54.170 A"LVARAC
5I-540 EISENHOWER DR.
L.R. QU1N7'A CA 92253
LA QUIN"l:A CA 92253
('760)564-4604 (.81,# 2261
USE OF PERMIT
4.38NERA,L ULi.tLDiNt)
iui.i7 41,5' GAtiDLIN WALL CITY STANDARD .
5 FT, WALL 50.00 LF
ESTIMATED COST OF CONS'9'.RUCfON .
1,va3r.t2...5s0
PERMIT E $f iit`.E SJJMMF1 $V
r: ONS'.f'.i 1Jcf KM N tr6,1: 101 -0004 t 8-00t) $7. 7.00
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S! 1B- OT is CONS -M..13(711 )N AND PLAN c -n ctc
t-7.7.00
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LESS PRE -.PAID PEES,
X11
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TOTAL :P€ #tM1T JIVES DUE NOW
$27.00
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RECEIPT
DATE
B1 l .•_•P/7
....—..—
?-d-- o •l • INSPECTOR
DAV/?-d--
INSPECTION RECORD
OPERATION,
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Retum 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 Llnes
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Backs
3_-_-_-7 — Gat.),
Electric Bond
Main Drain
LSet
Footings
Bond Beam �
1 3—e,
r' -Z- 6a
'
37
Approval to Cover
Equipment Location
�Gt7
Underground Electric
�^
Underground Plbg. Test
Final
��
✓
Gas Piping
l
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)