SFD (9907-005)`... , LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty.of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. ate
LLJ'� . 6740374 & , ` GL,1
9{
o rZ
ZY ate Signature Signature of Contractor -
CD O — rl�
J U C) OWNER -BUILDER DECLARAN'
TIO
HWd I hereby affirm under penalty of, perjury that I am exempt from the Contractor's
License Law for the following reason:
Z_ ( ) 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. fog this reason
LO
N Date Signature of Owner
O'N
Q5
Q WORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm under penalty, of perjury one of the following declarations:
LO O () 1 have and will maintain a certificate of consent to self insure for workers'
X W LL
— compensation, as provided' for by Section 3700 of the Labor Code, for the
co
0 J Q performance of the work for which this permit is issued.
Q. U (� I have and will maintain workers' compensation insurance, as required by
QU..;Q Section 3700 of the Labor Code, for the performance of the work for which this
fi rn. H . permit is issued. My workers' compensation insurance carrier & policy no. are:
"T -Z Carrier Policy No.
J (This section need not be completed if the permit valuation is for $100.00 or less).
O 1 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 becom-6" ubject to the
workers' compensation laws of California; and agreeAh'at if I shoul /become
subject to the workers' compensation prgv�islons.of Section 3700 o the Labor
Code, -I Vll forthwith cpop ply witli thos �C �vlstons�
Date J�� %s A licant { '"
VWarning: 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.
t:
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 applicaionragrees 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 "representatives of this City to enter upon
the above-mentioned propeft'y'for inspe tion urposes.
Signature (Owner/Ane Date �f
BUILDING PERMIT PERMIT#
7-41i1�
DATE VALUATION LOT TRACT
45, '28912
JOB S'1E
APN
ADDRESS
649-11&067
OWNER
CONTRACTOR / DESIGNER / ENGINEER
TD
SPAM CONS ti.LM.I.ON,
PO SO." ..i710
7M95 RANCHO LA QLfiAI'' A DR.
A QUINTA CA 92253
YEA QG t,A. LSA 92253
(760)771-.1941 CK4 2.996
USE OF PERMIT j t
y
SINGLE FA_MJJLY DWELLING
t—D - LOW PLAN NLS t - ;4'E121 l f DO1;s•.S NOT 114CLUDE BLOCK WELL
OR POOL. 75�o.1'.LAN 0.113—C .. FM "13d:Ti./r9OtdFOR Mr.11:STlk': fi,
ISSUANCE OR SAME PLAX f'YPE
Ci.i:.rTol"i c..,Ns t av— 1.1C`ai3 N.243.00 ar
ESTIMATED C'CZ`i's: OF CONSTRUCTION TION
350 .30 .
'FERMf7'3 E,R SUMMARY
CONSTIttic" YN FM 101-fDW418-ft)
PLAN (14130l FIFE,
�n
XWCJIANTIP1L F7: $1n3s63;
MAIC .iKYCAL17M, 101--000420-000 $246.7t
Pi t)1v11 ING FEE 101 -OW -419-000 205.00
4 Yfi,Q' MQ &J{Yi' 4(_ -N FI?E $35,14
1-11LA ;ll.NG FIXT $1_10.00
ABf W k'IML1:C:Pl..r CE'S -1ES1, 700.000-2'55=000 $678,47
S1.J,R=" AAL C:, NS f`KLIC'T70`1 ANT:) PLAN CHECK
$9,1.02,95
I.i, 'i�Tr -T'�A r iTLL$
11.0 0
�� ���
9 ■ �)q, p�,y+nye �+ '/
-.- .,: .R i 3. S'i• �l �.H. i�RJ �" S::�V�'AA. 9 1�iji;!ii. .f..'IU 'NOW
V9.102.05
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y^•
RECEIPT
DATE
BY f(x
DATE FINALED
INSPECTOR
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
- (j-
Exhaust Fans
O.K to Wrap
" .-- . C.v W,
F.A.U.
Framing_
f
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-3 7 CW
Drywall - Int. Lath
C.�}
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
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) r licJ