BLDG (0303-066)44180 Mariposa Ct
0303-066
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 Busines's and
Professionals_ Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Ta CIO CZ9
Signature of Contractor
OWNER -BUILDER DECLARA ION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Lawfor 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:
Lamer £3rATF ,Is'iD'ND :. Policy No. M2326411
(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 .Se tion 3700 of the Labor
Code, ash !I forthwith comply with those prove
Date: e` Applicant '''-'"^ . ✓ i w•
Warni 'ailure to secure'Workers'oompensation coverage is unlawful and
shall.subject anlemployer 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 at.0poses.
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Signature (Owner/Agent)-a = "" G Dateo
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BUILDING PERMIT PERM T#
DATE VALUATION LOT' TRACT
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JOB SITE
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ADDRESS, e14-180 M.. TlJF'QSISI. Ce0V1fjr
OWNER
CwTOEER
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LA QUINTA CA ?
MUD CA 92201
(619),347-0399 'alix n25
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USE OF PERMIT
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E.973M9 F'D COST OF CDS- IMMO
CONSTRUCTION WZ 101-000,4113-000 3S4.f14
MAR 0 6 1003
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CITY OF LA QUI TA
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$54,00
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RECEIPT
DATE - s` y^
BY `. _,_,-
DATE FINALED
INSPECTOR.-
..
. e 3
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
0. 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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
.p S
Electric Bond
Footings
Main Drain
Bond Beam
—Q '_'5 S"
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
( fj
Gas Piping
PLUMBING AP ROVALS
Gas Test
Electric Final
Waste Lines
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sevmr 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: