RC (0312-108)78010 Main St Ste 106
0312-108
LICENSED CONTRACTOR DECLARATION
,A-. ereby 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, hnd my License is in full force and effect.
License # Lic. Class Exp. Date
771a 83/ / 3q/0r
Date / i l Signature of Contractor, ✓
J ' r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I'am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
( 6 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 ST ME FUND Policy No. 1440123-07,
(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 worker's' compensation provisions of Section 3700 of the Labor
Code, I shallforthwit .comply with those provisions
„•,,D : Z ZZIii PApplicant _,!
r
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 inspect?p pu poses.
Signa ure (Owner/Agent):` Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0— '408 TRACT
/ ' / i 52,363.00
.:,4
JOB SITE
APN
ADDRESS i41 4•.6[ ..rna 11`d YJ Cava .
-
OWNER
CONTRACTOR / DESIGNER / EN INFER
OU) TOWN LA QUlNTA
MM`J"t d 1EItym 4
78.080 CAiii r F-STA;DO 9'15 201
?8-W0 C.ATIM-11X'-00 arE 2101
tfi QvZtq'1`r'i CA 927153
L.QtMRTA CA 42253
USE OF PERMIT
Co.'W ., t?.CIAL PEWOEM”
COMMiEiiL AL RFMODEL, (:.@.FLLAS.r°,P-.ePS T1) 613 S. F. `Wl' OC.CUIIANCY,
TYPE `" &PRUNK0.00CUPANT LOAD 2.L ZOOS CDC HP1A.CU PERMIT
0309.053
VALUATION 3,:6:1.00 w
.V, T9,1? COYS)..70F i.,CD.i' FS"ERUC'TION
' yy / '`I $ y` ( 'j' ' /f j, 'j3)tl ,
PM lr..LYR.Y A 1 XII'i b l {. 1V.iii•.C.Y lz F.
PIAN CHECK :+7:T? ' 307.000-439.318 $35.10
CONST JC"f'10N FFE 10'1 -000 -t#1.8 -d00 $54.00
M Z C HA N1C.Ai, F9A 101.000.421.000 $10.59
ELEC` RUC A1. M? 101-000-4,20-000 $27.25
E1'1'1 OM0 MW1014 FEE - C OMIA 100.000.2,41.000 5150
' '•x • CC31rfiMRUC'1109 d' b1V1iM[iW L1[L7:.CK
LESS 3"12L -PAW EMS
$136.36
$0.00
D
° 0: ', 1 '. 3?? 3: '1Vk3' t':3 MS ]XIX KOW
112003 .
$:13626
,
OF L ► (dlllfdT6►
CITY
FIRIAt4CE DEPT.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
0
INSPECTION RECORD
z
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
SefBacks
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steil
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utilitj Notice (Perm)
DEC -16-03 TUE 03:45 PM MARVIN HOMES
J4LA QUINTA
(,` till.DiNG APETY DEPARTMENT
v � 77-7012
�_ CJ7!`YCat "'��•_tNSP- N REQUEST LINE
��1f �Frt cry r f'1 777-7153
(a.l�D'+F()"�'1-N � A Q(TINTA
(contractor_.-_.,�gA,(IV ItaT )«Ul�l I.S
Cl3.12-10K
I:,bS'r ON JOIE IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ----------- -• • -----°T��O•Ir0"lvii�iN S'C'1tEF;'Y' SUIT.: 106
N1MERC TAI, REMODEL (Tl) M1!,RCANT1T,'E "tV1"
OCC:'UIrANCW S1111'E 1114 & 106, OCCUPANTLOAD 3'3,
TVIV, VN CONS'1 - Sk'E [NKLR1). E1',RC, MVAC &
Pf-0111ING VNi)I14 11ILk .1 T0211-194 2001
T%PE OF' IN$PErTION DATE IN'S P
------
7'CMI''U1i IIY PC)WL:Fi
U/6 PL(1M131NCa / WASTF
U/G FI..F'GTR1CAL / GROUNDING
FOOI INOS / ST EEL
GQNC„Fif-:TF__...—
DO NOT POLIN CONE
ROOF. NAIL / PML-FlOOF
OKAYTO WRAP
F" ' I NG (C O h� C3 Mj'-ION)
ROU(:�11UL)' I131NC,
45U(31 -I MI:C( IANICAL
INSULATION
L ABOVE SIGNED T
COVER NO WORK UNTIL ABOVE SIGNER
INI-[:ITIf)fl CYC! 13ra,-.(I?R`r_WnLI�_ v ��"'
EXTFR, IOR A–TFI
51; PTIC ABANDONMENT
")EWER C)ONNCCITCJN^__--
5I.:PTIC;
lv1ASONAY INSPECTIONS
FOOTINGS 1 STEEL
_-POOL I�SPA/ WATER FEATURE INSPECTIONS . _—
Pflf •GUNITE / SE'fEEr1CK5
U/G PLUNMING
U10, tLECIRICAl-
PftF: I'U1:;TC,Fl�Ala11'3►v1S ! f1AR111L"RS) "
— F1rdAl INSPFCTION5 �—
TF_'Ml? r- OF 1, 1. IN AN>-rIT C'UtiVI R
Ell"OTRICAl- `-- —
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M IANICAI
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COMMUNITY DFVfa_CJPMENT DEPT. -
. _ i.A.-.....--...... "*"-------,,--
FINL / JOfi CONIPLl;I'ID
A9OVF.. APPHOVALS 00 NOT INCLUDE RIGHT TO
TURN ON UTILITIES 09 OCCUPY BUILDING