MISC (9904-160)LICENSED CONTRACTOR DECLARATION
1,-hereby'affirm uncfer.penalty of perjuiy thit' ' ]'am licensed -Under provisions of
CKipter 9 (commencing with Section, 7000) of Division 3 of the Business and
Pio'f6ssionalS Code, and my License is.in full force and effect.
-License Lic. Class Exp. Date
64*'58 48,0100
1)aW Signature of Contiractor
-
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors
License Law for -the following reason:
I; .as owner of the property, or my employees with wages as their sole
co.mppn sation, will doAho work, -and the. structure is not intended or offered for.
sale (Sec. 7044, Business4 ' Professionals Code).
1, of �the property, am exclusively (contracting -with licensed
contractors, to construct the project (Sec. 7044, 1 Business & -Professionals
Code).
O I'Arn -exempt under Section' B&P.C. for this reason
Date, Signature :of 'Owner
WORKER'S COMPENSATION DECLARATION.
I h6reby. affirm uhd6i,'penalty of perjury one, of. the following declarations:
I have and will maintain a certificate of consent to self -insure for workers'
compensation, a`S1pirbvide.d.f6.r 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 37.00 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 notbe 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 shalVnot 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'• comoensatl6n provisions I I of Sectio . n 3700 of the Laboi
Code, I shall forthwith -porn ply. with -those provisions
V
DatApplicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall to criminal penalties and civil fines up to $100,000, in
addition t'o.'thb-cost of compensatio . n,.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 mit subject to the 'conditions and restrictions set forth. on his
appl16ation.
1..,Each.pprson upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
a,hy,permit issued as a result of this applicaton agrees to, & shall, indemnify
hold harrNess the Citypif La Quinta, its officers, agents and employees.
y 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.
certify that I have read this application and state that the above information is
6oFire'ct, 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/albove-mentionedproperty for inspectiori purposes:
V
Date SI nature 4
ature (Ownier/Ag6nt)
BUILDING PERMIT
DATE 4n.0199 VALUATION 59 0� LOT
,4
JOB SITE
ADDRESS 74-7O NIERMAN WAY
OWNER
onn %Arvv,r
'78-870NIERI1'lL.AN WAY
L A QU I N TA CA 92253
USE OF PERMIT 1
MW kBIS.IMINTIAL VW
PERMIT #
,).904-160
TRACT
APN
CONTRACTOR / DESIGNER ENGINEER
kJMIEL'A Ai%..1,4tI #LLt I LIQ 4 4.
7887 IMISSION GROVE PKWY SOUT R, HA
RIM."IRSIDE CA V2_506
(90)7P-7344. CUO 5720
REPLACING-14AU OF i STA00RIkOOF TRUS8JES. RITILAC N10 0XICTRIC
110IND-RUNS,U, -IMPALK 14V ' AC (X)NIKKLIIW,kO(.')F TIL8 2
WINDOWS AIUC(Glt"'111
t* AOU
IVALUATIK)INT
'MOSA LS
FXf IMATED COST 01T f—MSTRUMON'
PREYIMFEUMUMMARY
I
CDN3TRU(_`r10N FEE
101 000-41")Q
Mr
101 -000-4220-000
W.TMA010 FET;
$15.00
ST.RUNG MUVI'ON FEE -
10 140)441 -000
$,94
PLAN CTIECK
LESS, PR.'&PA1DFEt.S
TMALVER'MIT M"S OLVE'NOW
9,408JR)
$161194
$0.00
$162.94
I RECEIPT DATE BY I
DATE FINALED INSPECTOR
/I a JJ._� ._ I . / I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I 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 0 4aCompressor
Insulation 77
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
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
COMME�NJ S: /
„/o'G-7 ,�O/iC/l/if1G
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
Utitity Notice (Perm)