SATT (0012-121)78467 Magenta Dr
0012-121
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 Businessland
Professionals Code, and my License is in lull, force and 'effect. .
License #` Lic. Class Exp. Date
754118
Date „f ' /` '' ` Signature of Contractor. Y ' '" `r
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 Sectionn B&P.C. for this reason
Date Signa ut re of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm underpenalty 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 f6r which this permit is issued.
(.Y) 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 Policy No.
(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 3700 of the Labor
,.Code, I shall forthwith comply with those provislo
Date: '; • ' ^ Applicant ,/r• ` 7, s,9 ,
J --./.—
Warning: Failure to secure Workers' Compensation coverage 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 at
whose request and for whose benefit work is performed under or pursuant to
anypermit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its~officers, agents and employees.
I 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.
%1 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
, or inspection purposes.
Signature (Owner/Agent) Date °_, •per "T7
'Y
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
1.2t141r2( is ,t30
JOB SITE
APN
ADDRESS 78,467 In K4.43MMgA JIM.Vir,
OWNER
CONTRACTOR / DESIGNER / ENGINEER
BAY 0'1.°'Y . A M (AR=2 PA) Z1C'.
MMXJ11 C:C3VA"AN r
16 CAM MRCLTI?
7055 JONIDMIYe,
RANCHO WRAGE CA 922,70
RALM DER1?1ai CA 922603
bi1;/i`7 1'aty4. Cftf 3782
USE OF PERMIT
.ADD SIN CILE, CIARA 9SP.r' CE, O A.:XI :'@'3. 1.611,2-A,3: OAPA.0
aARAOR 7.0100 OF
FWA,#1V4`AlI.UD COST OF CU.I'1SMUC'!'ION
4&,802.0 3
t'}.,AN CH#. s 1n° REZ $46.80
sL02• STRU..7110N "Ifi irn.no
STROING MMON 9.1 UID 101 .000
fVM1-'1YYf L C0MTPRUCTj:0X AM) P-LMI MMICK
$119,30
LASS MU.-PAWFM
01S, 0,00
WTAL P0 W -Tr XNKS DUE NOW
$11930
RECEIPT
DA5 Er Y; r
BY
DATE FINALED
INSPECTOR
Q. ✓{'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
T DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
I1
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Insulation
r
;
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Z l Z
_ tom—
_
Final lZ ?
BLOCKWALL APPROVALS
Final
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
W "'G° YY ,' _rtj
fl.•
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)