SFD (0205-038)50075 Malaga Ct
0205-038
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
`Date r Si nature of Contractor
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. 11
N,V) I have and will maintain workers' compensation insurance, as required by
S ction3700 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 57AT'E FUND Policy No. 101.52
(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 -o -Section 3700 of the Labor
Code, cshr al.l4o wth comply with tote Pr.ovisions.
` r Li c A nFsJ
Warnirig: Feilure 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 ons `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 bbdv"e'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. for inspection purposes.
</j
/l f;'a t: -.w Date0v" iir
'Signature (Owner/Agent)
BUILDING PERMIT PERMIT#
DATE _ VALUATION LOT, TRACT
ZS207. ,S 170 , ,,,aJOB
SITE
ADDRESS :W-075 IALAil .`f i COURT
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SE00171.1.3OWS, INC;
rw°OTPOPATO1 T
PALM . ESPII T CA 92211
PALM =:lv;' l' :. CA 912260
(760)772-8224 )772.8224 '1137
USE OF PERMIT
01901A DiYF I LUTC
V0 WT 34 P1_a4.'N $. PERMIT DOES 11,40T INCI:UpL B'i3OCK WALL.%
Pr,)O , a?0A OR DIII'V•JVW:AY APP.R.O,A.C3 , 15% PLA14 ("HECK F9@
REDUC>TY011 Ilat3E TO MUTT2PL;P. ISSUANCE O 8.:h109 PI A11 TYPE,
C°UBTIO d3 C;t,"?.Ni>%'} 1,7(.° 'IC44 Z48P.00 SIS
RCHII.PAT1Q 12.5.00 Sli
R.041CARPORT 663.00 SIF
ES -MATED. C09.T' OF CO19 SWIC1'1'10111
20 71022,` lt3
.il'':EF,wrTh's Ui7.i" 3MAni'
CONST RUCTION RE 101AX16-418-00 3 $1,0.17.60
PLAN CT ECK k',i? , '101--000-439-318 $107.303
MECHANICAL FEE 101K000.421.000 $109,00
XLECTRIC.A.1,PEE ` 101-000-470-000 $131%
PLUMB ANC IMZ 101.000.419-000 r $10.100
S'TRO140 =710*N 1MLr - P,931D 101 -000-241 $20.173
C_ADD40 FEE 101.0,00.423-000 $20.00
1 1Lm"WPEP,1)yJjmC'9`°
Aa;.:d' IN PUBLIC P.LAC'RV91L 270-000-44441f1tl
913%i-J.h:V.td'iS,.F C01VSlgW.0.7,"VJ1A"V1:JvA
T,3'sjs
Q j 2iEBO'PRE-PAIDFE U,
S0100
TWAL PERWC FEES DOE NOW
"AlUri 2002.
QUINTA
FINANCEDEPT
x,
3i
RECEIPT
DATEBY
, r
DATE FINALED
INSPECT
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
, p G
Underground Ducts
Forms & Footings
Ducts
Slab Grade
v-_ v
Return Air
Steel
Plumbing Final
Combustion Air
Roof Deck
-/ - a z
Exhaust Fans
O. K. to Wrap
O.K. for Finish Plaster
F.A.U.
Framing_
Insulation
_
zs
_
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—
Drywall - Int. Lath
W_.,/
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
Final
Steel
Electric Bond
Main Drain
POOLS - SPAS
Final
COMMENTS:
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rouah Wiring I Af -,S h
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I. y
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
9 A
Underground Electric
Underground Plbg. Test
Final
Gas Piping -
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
v-_ v
Heater Final -
Water Piping _5
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
/
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Final
COMMENTS:
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rouah Wiring I Af -,S h
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I. y
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
9 A