BLDG (0305-069)53436 Avenida Martinez
0305-069
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
634981 S \ 1 01731 /2(
D'ate > 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 .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:
Carrier 3TATE 71,M, Policy No. 15420"-0.l
(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)l should become
subject to the workers' compensation provisions of Seciion,3700 of the Labor
Code, I shall forthwith comply with` those provisions.
Date: Applicant k i
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 asp vided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Direct of Building and Safety
for a permit subject to the conditions and restricts ns 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 herebyi'authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent), Date
BUILDING PERMIT PERMIT#
03(6-06
DATE VALUATION LOT TRACT
05"/M VALUATION
1 d HI.I:. 212
JOB SITE
ADDRESS -s AVIUMiA MAIMMEZ
APN
7,74—M2 -011I.
OWNER 3("e,
CONTRACTOR / DESIGNER / EN (NEER
CORONEL Ta 17MMSE5
CORONEL, Cc7N."1T"eCUMON
PO PDX 389
78.150 C:AUX, TAW,1CO SU['!" 230
IA QUINTA CA 92253
LA Q1.ngrA CA 92253
(760)564.46C4 CTL4 2261
USE OF PERMIT
G1*104AL BuffDING
150 LP 3' P.PTATNINO WALL PRK CITY STANDARD.
4 FT. WALI, 150, DO LF
XMN FIM COST OF CONSTRUC37011
2,400.00
MuffrfrLL913NMARA
C'.011S'iRUCTION FFIF 101.NO-418.000 $34,00
D
..O 1oOR1. 1, Fr -710 'AND PLAN CHECK
O
LESS PRE -PA's? FEES
$54,00
$0.00
y
-.11 Main, FFIES DUE NOW
CIN OF DEpt.
FINANCE
S54,00
RECEIPT
DATE /
BY,.--
DAT FINAy,ED / .
INSPECT R
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 8 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
67 - (2 -a —S.
Main Drain
Bond Beam
Approval to Cover
13A—
G
Equipment Location
Underground Electric
Underground PI . 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
OX 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: