SFD (0205-034)50140 Malaga Ct
0205-034
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 Signature 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 -o'w'ner 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 a 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 OT,&TI 1J? 1 Policy No.
(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 l-shall fort with comply with those provisions.
mate:€%' Applicant. _-rte t- .-•- s, & , j
Warning: Failure to secure Worker`s' 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-mentionned'property for inspection purposes.
S gnature (Owner/Agent).;Date!
BUILDING PERMIT PERMIT"
DATE VALUATION LOT TRACT
A 3
fB,Q 3012'5JOB
SITE
ADDRESS .i F3.f tx :CJ
APN }a t
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
l toxA.Hmyr a slac
11UR 11E 00M.R.AT16N
714564 t;ak y3*'" p.Y cL: z DRin mmu137•
7,1.1545 A, COTnm Y Cl..tm Z'dleZn. Sim 15C
P:A3.,.Z&ID&M, - r CA 32211
PA'i..INS $yi1". FIRT CA 9.i 260
(' z(1 'i' wiJ 2 l C"' 3i, ti ➢33'7
USE OF PERMIT -
9190111-4 F3Lyy T)vRJi•yT0.1ry1
1
. I a J_O'- 4 af;. PI,wA,N 3R. PE RM 00103 NOT INCLUD1? H1,QCK WA•I. L4
P0014 SPA OR i' RIVE', AY J PRO ACH, IM14 PLAN CHECK FEE
tq
C'►EIDUC'1 inti n, U TO MULTI PLZ IS ;I. KNCK 01P J:#1:N P,, ' LAia S t ?K
n
C U,k3T0M, C:ONSTRUC. I(N 2,629,011 $.F
PORCHPA.3'IO 216.00 se
P CefC`,4.h1'113T' 630108 ,SP
&'iUWM COST OF C 1DrN6f1ZUC X0Aq?
2,/a0AVUS0
Pd.;WT M MWAIV
CONSTRUCTION FEE 101-000A.16-000 11,06).06
}PLAN CHECK YZ1r 101-000-439-318 $21:5.38
MECHANION6 REE 101-000-421.-000 510,1459
XIXtC` RJCA1. FEE. ta140001 -42U-000 Y38,12
PL,'litt BI O "IL 1.01st'A-419.000 Nlnl2s
STPD 40 MCYT ION kt`VE - kESID 1 fila -0004.1-000
O SA IAiC: ? 101,000.47.3-000 $20.00
IC FIVE;.£' 084 W?Pl•+..C`P IES ClsaiflY 00.
ART N PURVIC'..P1 &=""' - P,. 3IF 270-000445.000 SAO
N
•
ppdPL®®Cy-
SUS -TOTAL CONnRUCIVION S
$3,690.74
d,6W.7iyVS'TOTAyyfV7nRUCIVION
1w, StS3 PFT-PATD.
$0,0
'FriAUG
121002
RECE -TBYE DATE FINWD INSPECT
Fl its z _ ! 3 .
—
r'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_/
Underground Ducts
Forms & Footings
ItDucts
Slab Grade
1K
Return Air
Steel
v
Combustion Air
Roof Deck
Q - .may
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing/
Z
Compressor
_
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
CW—
Final
-
Final —Z
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
C% /
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
A13
Equipment Enclosure
,Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 77 -
-Low Voltage Wiring
Low
Fixtures
Main Service
Sub Panels 14-1
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 2-1
Utility Notice (Perm)
COMMENTS: