SFD (0205-036)50115 Malaga Ct
0205-036
Y
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. z' Exp. Date
3^670 1vWC, f111-10102 .
bate FilliSignature 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:
Carver pn.f:4'.F, FUND Policy No. 07152 .
(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 Lalior
Code, I csl ajllforth„with comply -with those provisions. '} l t, /,J _ '4
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 property for inspection purposes. j
/Signature (Owner/Agent) + '• Date'
BUILDING PERMIT PERMT0.W&
t ryse 7
DATE d VALUATION y `)q) LOT ,I) TRACT 30,125-1
JOB SITE ADDRESS. II'S tfAL„ GA COURT
-7
-7 /3„0,221 021
OWNER
CONTRACTOR/DESIGNER/EN (NEER
PALM CA 92211
P1111M 1). UITW;r CA. 92260
(160)772-8224 M'' :Il11:4'
'
USE OF PERMIT
i
,,;FO - LOT 31 PI ATf 2. PERMIT 001Z NO''!`' INCLUDE BI.C7Gt., .' W1L1AB%
P'0014 OR&OR DPWl'6V; '{T,t+iP.PROACK 'M% PUN CHECKFRE
"'Twe`1 old nt4if?'. "'O 11&CJPA1 V., 111MUMWE OF SAM, Pi.AIi TYPE,
C11.3TOM M2 rTRUCTM Z4111110 SF
car cm .r.► 13100 art'
GARAWWO ORT OF
ATM) COIN CONVEXYL N
'ESTM ST OF -170.
207M 700
;PMMa.rSiRE gC hWYARY
C YOSTRUCTION ME 101.0014118.000 f1,Q9 7 5 i
PLAN i:FiuC:9112'
MECHANICAL FF9 101.,000-421-000
.&.f:C°t ICAA."11:1 101 170 t.2S3-(3Qg fit. j.5ti
PIXI A.1fi G FEF 101.11000.41'9-001
'i'P. W016gOTEC;YN FEE - M, 10 101-069-241-000
(RAM90 RE 101 ^000.423.000
1XPVrA,0P 1r,R IMPACT MIZ i If9Q7.f3D
ART M PUBLIC PLACES RM11 ZIO- 00-4 45.00Q - a19.5i1
R U0.14 CIV
OLTD-TWAL COMM. DIT AND MAE Mr,
$3,599.75
LB.1173 ME. -PAM Mr -13
DIM X0 9'7
Hhl'AM 75
AUG 12 2002
C, 1-T 4F tAQUINTA
FIN/ANCEDEPI ,
RECEIPT .
DATE
} .. 4r 7
BY Lp r DATE FIN//ALED ZZ
;
INSPECTO C
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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
— . oy
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
i
Final
Final —
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
-
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
Water Piping
9_
f) i
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
—
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
—7
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final _
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring ZO
Low Voltage Wiring
Fixtures Z
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) 2
COMMENTS: