301-0136 (BLCK)
54800 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 ExpfDate
634981 B I ,1/31/U4
/Date 1 ' `t • ~ Signature of Contractor'1"C)1\-
/
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'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 workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(5 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 STATE U D Policy No. 1542937-01
(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, arjd.agree that I should become
subject to the workers' compeription provisions of Se tion 3700 of the Labor
Code, I shall forthwith comply with those provisions.
' Applicant – 4w
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 attorneys 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
construction, and hereby authorize representativestof this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) r`.- Date ! ' -S
4.4
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BUILDING PERMIT PERMIT#
DATE VALUATIONLOT QY} - h TRACT
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ADDRESS X800 AVEN1DA ALVAR, fi• i O JOB Slit
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OWNER
CONTRACTOR / DESIGNER / ENGINEER
Co3:t.C)ENTERPR1SES
CORONEL CONSTRUCTION
PCS BOX 3€9
78-1 50 C
AMPICO SUrrE#230
L A QUINTA C.A. 92253
LA QtalTA.
CA 92253
(160)564 604 CNA 2261
USE OF PERMIT
OI?N._ItAL B UDkDIN'G
150;,P. COMBO WALL, 4' RE'i'.AININCI, 5' UAR1).LN & 100I.*. 6'
GARDEN WALL ROTHORC;O SYSTEM
d 1''T. WAI.;1. 259. DO 1,14
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p y ' 7 y / yp'♦ [Ei' r.ATPIr COST" OF CONSTRUCTION
r.1: vi i d, i zE !y W.L1rild'3aY:41
6,250.00
CONSTRUCTION int.J 3 01 -000418-000 MN
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La u
JAN 0 9 2003
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CITY OF LA QUINI'A
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FINANCE DEPT.
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SUB -TOTAL
CONSTRUCTION' AND MAR C iI
$.90.00
LENS PR fi'AtDJ1..E3
SD, 00
*AMC, mm r rEEs DUE NOW
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$90.00 -
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11111111153
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RECEIPT
DATE
BY
DAT FINALED
INSPECTO
INSPECTION RECORD
OPERATION
DATE
INSPECTOR.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fomes & 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 Lines
Party Wall Firewall
Exterior Lath
.
Drywall - Int. Lath
,
Final
Final
POOLS - SPAS •
BLOCKWALL APPROVALS
Steel
Set Backs
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7 '� 54 7;
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APPROVALS
Electric Bond
Footings
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Main Drain
Approval to Cover
Equipment Location
Bond B am (
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— Ate'-`-
Underground Electric
Underground Plbg. Test
Final
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Gas Piping
PLUMBING
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:
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Final
Utility Notice (Gas)
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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
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Final
Utility Notice (Perm)