BLDG (0306-298)78900 Lima St
0306-298
Chapter 9 (commencing with Section 7000) of Division 3 of the Business an
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Date"0d ./'y Signature of Contractor �� ' �f� a=�•�
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor';
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sol(
compensation, will do the work, and the structure is not intended or offered.fo
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with license(
contractors to construct the project (Sec. 7044, Business & Professional:
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.
(.') I have and will maintain workers' compensation insurance, as required bl
Section,3700 of the Labor Code, for the performance of the work for which thi;
perAit, is issued. My workers' compensation insurance carrier & policy no. are
Cartier ,i°j'e'f?'r. Cf�bdld$t9�T Policy No. (1�y,.fSa awt�3
(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 37.00 of the Labol
Code, I shall forthwith comply with thoe provisions. r
Dater Applicant f >. fi / �'•� �r
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 al
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicator 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 it
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 property for,inspection purposes.
f
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Signature (Owner/Agent) �_ :r .�. f ..� ate
NGPERMIT PERMIT#
f 0306-298
I DATE �VALU ION LOT TRACT
JOB SITE APN
ADDRESS
OWNER CONTRACTOR/DESIGNER/EN (NEER
CAPTTPJ :PAM7,3'C 1101yYZ DTV;
41.00 M, AC ARAM13LVD #200 esu.. Igo .rA;'i ENI°A 54
KOK i�:l�?'t FOX73 CA 92660 Ck.)AC A C.A., {x'22"36
USE OF PERMIT
60 :_. " f' 4"IARDFIN `VAU, CITY STANDARD
RMULMT) con. OJT C01MUDRUCTION I ism, 40
is.iltU'� -000-41 k -00-01 8:r 5,ii0
RIB_ AY AL i'.XMrR..UCn,0Nr AND PLM }_.1fH 4K �3S.Ot3
'PRIG%, -PAID' FF v
JUN 20 2003
.1
CITY" FINANCE DEPT.
RECEIPT DATE BY 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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam ..
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
aste Lines
Heater Final
Water Piping
Plumbing Final
lumbing Top Out
Equipment Enclosure
` `hower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation �p
Gas Piping
Gas Test.
Appliances
Final—
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)
COMMENTS: -
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