SFD (0205-037)50095 Malaga Ct
0205-037
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
%533/00• 1 i ztu
DateSignature 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.
.) 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 1jT ' r,, . k%T.15 Policy No. t d1 I2
(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 provisions. ,
Date / .....-y Applicant E,< ` jf fel V
Warning: Fallure. 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 thecost 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 theabove 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.
S'
Signature (OwnerLAgent), / ''S+s.#n - Dater /a T)i'
I
BUILDING -PERMIT. PERMIT#
V
DATE VALUATION. .bakso4o,..m LOT . 3 TRACT`
01 '1
JOB SITE
.ADDRESS „ S1,Y^1 .A. a7/l. T AC)A COURT
APN 7711-M-021
-021
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CNA 110MES, INC
S.T MOSE
77 564• COW -MY C:LLD 331 WMt 3UUJ,? 131
'77-645A G'OUMRX CLUB DIUNBM, IT, i 50
PALM DWRF f CIA 922121
PAL'I A DEUSIR ' CA 9_1260
CtsX172-822:s CPMA 1 311
USE OF PERMIT
SFD,- LOT 33PIAN ZMKlIT O'T.,NOT
.LOC::wus;
-
.POt5L,,,q AOf3:RFVy- fPPRO-e'A.li. £foPLylCHECK ME
Is,E.r UCTICrN DUEE TO InUVrfI3I..E I'VSL!ANC)t car aA:M'E, Kakki TYPE.
CUSTOM CC3NS'I RUCT1, 11 210910D MT
FORCHIP.A Y0 216m sF
EgnMATED COOT OF
COW' R'UC'TION Fix, 1101 -0y0-4M-000 $1,063.00
`0
PLATA CHFICIC 1 AC '
1WHANICAL YES 101.4..0.i3i-421-000 $lA2.SS!
I'aLi<.CTz .dfro . T't'.,L 1 1 d1G''• a?,(JUt1t} fiik 1 S
IgLUM131NO FRIG
5'1`RONO MOTIOW PEA. 11.E ID; 101-000-24 2 -000
CIf€ l3 i JNC3 I±.f 101 _C 00_423 lr 00 Is'ka0
DP_`•`IfRti':. PER IMPACT FEE
d wr Cid 1'i,Jsuc k'ucil:n • 1<ti;£IIL vp C1Qp445.000 $SP,05
x
't
5 tTC"1.CC? If , hTD 1?1A.T L';, 11 1w
D 6
s -,h Ci.'i
A :l 1 12 2002
3,690.74
CCff OF LAQUINTA
P
FIAIANCEDEFF
RECEIPT
DATE
BY:
DATE FINALED
IN
4 i
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- C/
Underground Ducts
Forms & Footings
Ducts
Slab Grade
L
Return Air
Steel
Combustion Air
Roof Deck_
_
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
_
Vents
V
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
-3
POOLS -SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
Gas Piping
PLUMBING APPROVALS
.
Gas Test
Electric Final
Waste Lines-
_
_ G
Heater Final
Water Piping
_7
Plumbing Final
Plumbing Top Out
_
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connectionf:
(/ U
Pool Cover
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 2
Utility Notice (Perm)