BLDG (9906-148)53745 Avenida Madero
9906-148
LICENSED CONTRACTOR DECLARATION~,
s I'hereby affirm under penalty of perjury that I am licensed under provisions of
t F " Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 (LnLJ 'Professionals Code, and my License is in full force and effect.
c,) ; License # Lic. Class Exp. Date
- LULO
425381 I3 07131/20(,,x,,
Signature of Contractor,
C, Z r` . .
0 O. r- 1 y
J U ' OWNER -BUILDER DECLARATTICN
W LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~;4 License, Law for the following reason:
1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and tKe structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).,.
4'
( ) I, as owner of the property,( am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business -& ' Professionals ,
Code). '
a;'. Cl) O I am exempt under Section B&P.C. for this reason r'
' N Date Signature of Owner
O rn
. Q WORKER'S COMPENSATION DECLARATION # '
C) , Z' I hereby affirm under penalty of perjury one of the following declarations:
U-) < O (, ) I have and will maintain a certificate of consent to self -insure for workers'
W compensation, as provided for by Section 3700 of the Labor Code, for.the
O J Q performance of the work for which this permit is issued. i
"m Q, U ( I have and will maintain workers' compensation insurance, as required by
';.O U.. Q Sectl n:3700 of the Labor Code, for the performance of the work for which this
LO
0 H permit is issued. My workers' compensation insurance carrier & policy„no. are:
N, Z Carrier Policy No..'
003'TA '1, IFUN1;a
J (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
r' workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
•\•77 C 'de, I s II fort with comply with those provisions.
ate: • t CA`pplicant
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 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 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 pro 1pertrtyf or inspectiogrpurposes.
^ igature (Owner/Agent) " Date
}
i
+
BUILDING PERMIT
PERMIT#
DATE 06/,JR/1!a4,iVALUATION $3,3555.75 LOT
TRACT
JOB ADDRESS 53'74.5.C .' rJIt I'k: :OA!%,t grlr o
APN
NER
,OWNER
CONTRACTOR /.6DESIGNER INEER
CAn tf4flDES CONCT"L014P.
rH,EE.f.w.Cii.✓r. !, A'4
JEfN.G] . .
.1. -119 $1 RFIVION•'i
1719 S TIMviONT
SCW_'.EANS1DF CA 920.54
-SUCEAN 216 CA
92.0541
7r( 7 tx 9 ca •r.v
ss
USE OF PERMIT - ?'•'
a
155L.F.19a'.GLOrX WALL.Aa'3iml'
;
5
JFe' WALL
,
-
9
COs -i
or I,p: i:
PEAjiW I i. FEE, SUMMARY
CONSTIt,Ut TION F.U, t0:i-0{1{)-11.]11-I30ti 563.00
}.
St;MI-TICY.. :! ONSi°Rt t.3!40:x•A MP. ,Ay'N c.-y+' !f
TO 00
LESS t
t''S\. •'A"1'1,1-1, 1 .
+}z . V
TOTAL !<'I .edMjl i .FEES .ADsI DUENOW
$63.40)
RECEIPT
DATE
BY 4,
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings —
Main Drain
Bond Beam
Approval to Cover
Equipment Location
—tv
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING PP OVALS
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)