SATT (9710-053)78449 Magenta Dr
9710-053
T.
-'LICENSED CONTRACTOR DECLARATION
I hereby affirm under -penalty of. perjury. that 1 am licensed under provisions of
Chapter 9 (commencing with Section 7000): of Division 3,.of,the Business and
Professiorat s'Code and my License Is In full force and effect.
License # Y Lic. Class Exp Date . ...
'Date 11,
Signature of Contractor i1i
% ,rL
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' ,Js 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)... ;
O 1.am.exempt under Section B&P.C. for this reason'
Date Signature of Owner
`'
"'WORKER'S COMPENSATION'DECLARATION "
I 'hereby. affirm:, under penalty sof' 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 permitis issued.-
(':. I have and will maintain workers' compensation insurance; as required' by
`Se6tion>,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:
Camer' . .Policy No
176.)2
(This `section,need•.not. be completed if•the permit'valuatioh:is f6r.s16o.00.or-le§S).
( ) ..I, certify thi i in the performance of the work for which this 'permif is;issued;
I. shall not employ anji, person in any, manner.sd as to become subject to. the
workers' compensation laws of California,. and, agree that if .I should become
subject to4he.workers' compensation'"provision•-WS ction 3700.of the, Labor
Code,,I shall forthwlth•comply with, o§e'provl Io
Y
,Date , f 2 Applicant r 1
{
Warning.1F.ailure to secure Workers Compen }tion coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up: to.$100 000, in
additio.wto the cost:of compensation damages as provlded•for in Section 3706
of the Labor Code, interest•and attorney's fees
IMPORTANT:Applicatiorr'is hereby made to the Director.of Building and;Sarety
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 orpursuant to
any permit issued -as a, result of.this applicaton agrees to, &.shall; indemnify
&'ho ld'harmloss 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.
Jr.tertify that I have read this application, and state that the above Information Is
correct. f 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:
Si nature (Owner/A ent) '-• Date
BUILDINGPERMIT PERMIT'# CONTROL/Y ;•
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DATE 'g q '7 :VALUATION S A . LOT' j' I t. •• TRACT/78
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JOB SITE
ADDRESS'
OWNER - 'z _. -.. '_. r - - _
CONTRACTOR /.DESIGNER [ENGINEER
'01AY Crim r nc° (.' t:tZp n `.;A)' IN
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$477 N11` 60 0
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DESERT -NOT i?itTNG CA 240
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USE OF PERMIT
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$1,V29-33
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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 Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
L
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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 4r
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test i
Appliances t
j
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 /9
Final
Utility Notice (Perm)
COMMENTS:
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