BLDG (9803-046)54585 Avenida Martinez
9803-046
LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of
ChLlAr 9 (commencing with Section 7000) of Division 3 of the Business and
Forofessionals Code, and my License is in full force and effect.
. . License # Lic. Class Exp. Date
VDate — // 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: S
( ) I, as owner of the property, or my employees with wages as their s91e
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 licensTd
contractors to construct the project (Sec. 7044, Business & Professiondl's,,
Code).
( ) I am exempt under Section , B&P.C. for this reason I
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declaration's:
(k) I have and will maintain a certificate of consent to self -insure for workrs'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
(4,) 1 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 shall forthwith comply wit those provisions.
, w
fDate ' '' ' y Applicant t 1_0
Warning: Failure to secure Workers' Compensation coverage is unlawful and f
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 inspection purposes.
Signature (Owner/Agent) f` _. -61 Date C-1 Ire
BUILDING PERMIT PERMIT# CONTROL#A
/
DATE VALUATION LOT 9800-046 TRACT 8 G Q _q
VVV
V
3112/911%1.125.00
JOB SITE
ADDRESS
TPN
5§4585
4285-0112
OWNER,
CONTRACTOR/DESIGNER/ENGINEER
RALPH HANNON
I
DESERT ISLES LANDSCAPING
545135 AVENIDA A•!AR rTNU
40260 GALINDO
LAQUINTA CA 32253
INDIO CA 92202
{160)345-3585 CB:Lr#
USE OF PERMIT
01 fit 1111Rt
45 L.IF., 6' :.GARDFN WALL. CiTY STANDARD, WITH PLASTER FINISH.
6 FT. WALL 45.00 Lia
"WIN1A"1'ED COSI' UIQ CONS"fRUM ION
1,12s.Iti1
PERMIT FEE SIJNf NL4.R1'
CONTMUC; PION FEE 101-M-118-000 S29.00
D. -AID
AR 1998
CITYOFLA
QUJNTO
SUIS -TOTAL C0N.Si'RUC`f 10N AVID PUN CHECK
}.'•1 W
LESS PU-PAID FCls5
$(i.i l
TOTAL PERMIT FEES DUE NOW
$29.00
RECEIPT
DATE
BY /{
DATE FINALED
INSPECTOR
FA
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Footings
Electric Bond
Main Drain
Bond Beam _
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Fic)al
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.
IjSmoke Detectors
prTemp. Use of Power
Final
'Utility Notice (Perm)
COMMENTS: