RC (0309-051)78080 Main St Ste 102
0309-051
LICENSED CONTRACTOR DECLARATION
"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 # p'Lic. Class Exp. Date w
it r t SPI
Date r'" Y Signature of Contracto f '
s g r'; • .rte- „
OWN ER-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 isnot intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044; Business & Professionals
Code).
()
Cam exempt under Section B&P.C. for this reason
,Date Signature of Owner I
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 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, I shalliforthwith comply with those provision's.
Date p f Applicant—
Warning:
pplicant 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 applicator agrees to, & shall, indemnity
& 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,in4ection purposes.'
Signature (Owner/Agent)/iDate G % J /''
BUILDING PERMIT FERMITp
DATE VALUATION LOT+; TRACT -
JOB SITE
APN
ADDRESS
OWNER f
CONTRACTOR / DESIGNER / ENGINEER
79-08f) CJ1ILIX,- BUTA0 "'na:;f 2,01. .. .
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USE OF PERMIT
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P'146M CHECK FEE, TMe'D
C;GNSTFct}( rioN i/Y•E• . 11,.0.)0? 4i8-000 00
sfi$2
sFON'WT1.0tO)rAk1, 100-:3441.00?
. 0.9 2003 "•
SEP .
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CITY OF.LA QUi I'X ?.
FINANCE DEPT. !41"
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RECEIPT'
DATE
BY
DATEFINALED•
INSPECTOR
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation 273,37 a T
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
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
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
Utility Notice (Perm)
COMMENTS:
DEC -16-03 TUE 03:47 PM MARVIN HOMES
Y,
LA QUINTA
BUiI.L7iNG & SAFETY DEPARTMENT
%77-7012
�,INSPT:CTION REQUEST LINE
- X77-71 S3
Owner CDT�l9'C�)`� IN �,A &INT' A,11AC__ _.
A
Coil .._.- VATIVI111 1j0MFAS
Permit Number 0309 -051_ ---
POST ON Joe IN CONSPICUOUS PLACE---
MSPE=C_ OR MUST SIGN ALL APPLICABLE SPACES
dOB nDDREs, 8-0 (I MAIN STRUT S'FE,.102
_`_.,,
ta�MIVICRt:IA1.LZ!✓MC)i)Ca (TC) tbil'f2C'AN1'ILF rii� UCC'l1PANC Y
Siff('), 101, OCCI PAMT LOAD 23, -I'YPE VN CONST - SHUNKLIr:U,
P.LEC, CIVAC & PIA)M91NG UNbF't PERMIT 0211-194 (2001 CCI(:)
TVPI: nF INSPEOTION
'I•EMF�t)(lARY PC)WFFI--....� _..._
U/G pL1.1MI31Nr / WASrE=-
ll%G I:FI-1, -CTRICAI_ / GROUNDING
60NCI3F f[ SLAH
-- 1.70 NOT POUF CONCRETE
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OKAY IU WRAP
Fr
- _—,_--
Fr •1_146 (COMBINATION)
_JIGH LLF(,TRI(..,' - --
f{c?UGI) P['.R-6 1'N- z
ROUGH MECHANICAL
DATE -]- INSP.
ABOVE SIGNED
COVEN NO WORK UNTIL. ABOVE S
INfF;RIOR GYF' f�17. (Ul�YWAI �;1^c
_':XTERIC)FI LATH
GAS TEST
SC P'TIC ABAND(�NMI;N_Y' LL
SEWER C�C)1IN1=CY10N
SE_P'fIC / GREASE It TEHCEPTOR
NIA aUNRvINsPec'nONS
O -
FUTINC, ; ---
POOL/ SPA / WAI ER FE,
C'R_F GUNI"TIY//S_ETIlAC1(S
!)Al PLUMI11NGi - —'•_.
f�RE PLASTER (ALARMS / DARME S)
FINAL INSPI
raw U^F: OF PCf1Mr\N NT .._-Fi
Fl_f=6,T* RICAL-
I'L.lJMF31N�3
t?� .,C WORKS MPAR I'MENT ---
LOMMUNI I Y I�L'V(;'LOPMENT_DEPT.
FINAL / JOIR COMPLETED_ -_
,7URE INSPECTIONS —4—
AE30VE APPROvAL.s DO NOT INCLUDE RIGHT TO
TURN ON UTII.ITIF_S OR OCCUPY 13UILDING