SFD (0205-029)50040 Malaga Ct
0205-029
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 Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Datef % F' Signature of Contra'Eor_.
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 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 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 STA` 9 FUND Policy No. p71+S2:
(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 'f
Section 3700 of the'L'abor
Code,, shall fort with comply with'those provisions '
1 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 -oto 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, indemnity'
& 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 hat the above information is
&a
'correct. I agree to comply with all City, and Statelawsrelating to the building
construction, and hereby authorize representatives of this`City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)/-y•r `-1 _ Date
PERMIT #
BUILDING PERMIT
02 .,029
311. y1.
DATE VALUATION D .D rA f LOTS TRACTJOB
SITE
ADDRESS 50.,("}4.0 Al"' + C IA 1COUPT
APN
OWNER,
CONTRACTOR / DESIGNER / ENGINEER
Y7 5564 C•O't:3'.i.7'l.R1' CLUB DWYE SMAM 137'
71-645A COOI IRR '( AJB DRIVE ,`'3Lr' Cam: 50
1',1t1: DESTO.'z CA 92211
PAl:.,l>/.t DESHRT CA 92260
`
Q60)172,=823.4 (113141 1.137
USE OF PERMIT '.
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'FINANCEDEPT
RECEIPT
DATE
BY
DAjE FINALEOD
INSPECTO
P, 2
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
&p—,, -,Z
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
B
Compressor
InsulationVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
>
Condensate Lines
Party Wall Firewall
Exterior Lath
'L
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
_ _ G
Heater Final
Water Piping
Plumbing Top Out
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
�� ,p ., �i
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS: q*
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)