SATT (9710-056)78455 Magenta Dr
9710-056
LICENSED CONTRACTOR DECLARATION •;
A 'hereb,y.affirm under penalty of; perjury that I.am licensed.'urider.'provisions of
Chapter 9 (commencing with Section 7000) of .Di'vision 3 of the Business and
Professionals Code and'my License is in full force and effect.
Llcense # $ of (` . Llc. Class Exp. Date ),
34 t 6 f3i :• ` i'lr 793'
ate"'/✓ /Si nature of Contract -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury,that I am exempt from the Contractor's
License Law for the following reason:
owner of the. property;' or my employees with wages as their sole
compensation, will do the work,.and the structure isnot intended or offeredfor
sale (Sec. •7044, -Business & Professionals Code).
('} 1 .as owner"'ofthe:property,.'am exclusively contracting With licensed
contractors to' construct the project (Sec. 7044, Business &. Professionals
Code). '
O I.am exemp"rider Section B&P.C. for this.reason' '
Date Signature of Oovner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of. perjury:one of -the following declarations:
" I,have and will maintain 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 by
Se on 3700,of.'the'iLabor Code;.for.the'performance of the work for -which this
permit is issued. My workers'"compensation insurance ca`iider:& 'policy -.ho. are':
Carrier 1 Policy No`
p E to ;f :f f a i IJ✓ ^ G-`fit €tfi r w -i TJ
(This section need not be completed. if ttie permit valuation is for $100.00 or.less),.
( •) ,I''certify that inYthe performance,of the work:fo[,which this permit is issued,
(.shall not employ, any. person, in_ any manlier so as io 'become`subject to. the
workers' compensation,law's of Callfornla',and agree that ifal should become
su tectao the workers': compensation provislons'of S ctr n 3700 ofahe Labor
Code,) shall'forth.,wit comply with tho fe rovlslofns `. ; ''%•
Applicant' f `
Warning:"Failureto.secure Worker`s 'Corripens tion coverage,iS.unlawful and
shall subject an employer to crlminaV enalties and civil 'fine up to $100,600, in
.addition to the•cost'of compensations"damages as provided for in Section 3706
.of the La6o'rr Code, interest and.attorney's fees,
IMPORTANT:Appllcation is hereby made to the Director.of, Bulldmg: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 Quinti; its, officers; agents and employees.,
2 Any'permitissued as'a.result of this application. become.
ecome s. null and void if
works 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 informatlon:is'
correct: l;agree`to comply with all'City, and.State laws relating -to the building
construction, and' hereby. authorize representatives of-this•Cityto enter upon
the above-mentioned property for inspection purposes.
t F
Signature (Owner/Agent) = "~ '' -Dat ! ✓t f'1
M..:. r
BUILDING. PERMIT' PERMI # CONTROL /1
DATE c) .1 .) VALUATION $j 6+1.0 LOT , - , w — TRACT , .
_40.81
JOB SITE
ADDRESS . '7#;"4
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ti a t+ nnr ,art 'Pr t (Alt [ iY>9ar 0' !r'
,1'✓hf i . .% 1 / 'A,t ,f t O..S (Alt J.f.rV✓1 iii 7 LI.Y . ,'
1 4 IYi 15 R l rl►}{" > (rr I ?. £ 1
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'LA QUi..'.KrLA - CA "iW
i F8F CJ= HOT tiui2lNQ CA 9274 }
ft IT) 3329-5490 193415
USE OF PERMIT
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. . INIPT .OS a OffCC\"TaIrrx0N
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PERM FEW7,➢W71RY .. .. . -
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r`v3.'t4 1A1`3ICALPEF,5' _ iQl- 'tt)- S? 94$.00
hr t inittE.At 1FawR.. I,0rAKJO_.,V.2(tC}fj $f9 . ►5.
1r'3.t)2'+=e8jN`Q "A. 10JI-000-419-M) $97.50
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RECEIPTDATE
.: ;
BY
DATE FINALED
INSPECTOR,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 19qu
Underground Ducts
4,
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck —(Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing v
Compressor
Insulation 7 7 7
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 AP ROVALS
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) 2117177