AR (0208-326)50135 Malaga Ct
0208-326
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
33 l - . i.14..N" i►. ]0/1'12
,p
Date ✓Signature of Contra for- "
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.
(4) 1 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 0TAJ'r, F+tIVID 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..provisio s of•Section 3700 of the Labor
Code, I shall forthwith comply :wifFi ihosefprovisions. F f, , ,.• 7
I 1 !i 1
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fine's up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of th* <1abor 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 a ,
& 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 applicatiori 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.
iz
Signature (Owner/Agent) -> n - )o Date 1 s 'f",d
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 11 TRACT 30123-1
JOB SITE
ADDRESS 50-.1,Je5 a La.V .eA(-, ,A C UTLk` APN . (ynv ral
77-564, 4oOMMd. CLUB 1.I.11IYEeM 37
PA L M 1) ES, FAT CA 92211
CONTRACTOR/DESIGNER/ENGINEER
SIS ITRI;1., COX° OWXKW -
(1 0; 7-12.877 t.S191 1137
USE OF PERMIT
RMWMi rl.Wl"Alrl:MUM
SM-YPIJt U184 :dAL O PEP.MT # 070-015- 112 S.P. C:O1+IVf:fiS:ION OF
1 CAR. OA,RAC!E TO HOOKY ROOK 1)(TRINQ YAII`2"1AL MWEI'1'liiiC'C1:OK
HFat APFtMiJ"ED PLANS I'
CON': PL C1' AMOUNT , g2 ,4i41
OF COMMUCA110A,
3 II7Jt0 SiMrY
CONS9'RUCTION FRE 101.-000.428-000 $90.00
MEMAIlle U, FEE 41 o! -000421 T)oo $19.
k 1Xe'CTfUC-A1. ,WM 101-000-120-000
STR(7NOMOTION YEE,.RESID 101-000.2AI.000 $,6
g. C- ,-`l`'kxA1, tmm'1.7CTI0..44AWD I W C-8 R (M OA -50
OCT
0 4:20 2 TMAL a1=ifff E DTIE NOW
F LAQUINTA
RECEIP.,T DATE r BY DTE FINALED INSPE T
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
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
f
Plumbing Final
Plumbing Top OutEquipment
s
Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Sewer Connection
s
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 e
_
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 3
Utility Notice (Perm)