SFD (9907-370)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
' 6 3 7 2321 B 102%29%22(
Dated Signature of Contractor _4A
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(js)o1r`h`ave 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.
a ISL I NS. CO.
(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 with those
Dater 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 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) Date
BUILDING PERMIT PERMIT#
9907-37"
JAN
® t�[i 2000 VALUATION 1.14'#9.3 0(' LOT 63 TRACT 2X60 fJOB
SITE
ADDRESS 79-720 1MUtZAFLORES UOULEiVARO
APN 649-030-020
OWNER
CONTRACTOR / DESIGNER / ENGINEER
C,N"'.TL US ftESll)WI tAL Cf)NIMUI` MII'S
IPI:; CAI'L;1J."I'S K SIT}g; tAE. MNS T.. INC.
5 PiU M PLAZA S'1'f 400
5 i'tlTi,K PC.r1%t''ti, aUrm. 400
1XV1NE CA. 92614
RVINE CA. 9261.4
(v a9)251 -ti 100 CRI -4 5072
USE OF PERMIT
SINGLE FAMILY nWILING
tD - LOT 63I ikK LR. PERIMIT D6.0 NOT AINCLLT iR BLOCK WhIj, OR
PC)0J_7_5'D/; PLAN ClAh :K R0)U(,T1014 AJVV1-. F) FOR. MULTIPLE
TRACT CON �riR(JC'fION 1,914.00 S1,
POtt097?ATIO 120.001)F
C,iAR VJ /C:ARJ?Q1C1' 410,00 S
P.r RMiT FFIE S°iMtViARY
C0N1 T1,tUt: t'19N ti'a, 101-000-418.ON 56920i
P1, 4NCFIIf•CK,�'i•4°i30
f .
-
W.E,1 TJ.12XAL FT --E 101-000-420-000 $125. t 5
.
141.UMBJ14 1 M.1-1 10i AW -419-000 S1S4.00
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01Ukt N(3]..,2 I01-000-4123.000 $'a.()t)
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lot.
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4411'x-'Ky All f,('?WC'1'tILUM ON! ?11vtYPI AN MIF.CK
$3.1 Std 9A
LL SS PRL—P.AID 113 f3
$000
$0i.A,L PERMUF MKIVS SIt7. E NOW
.7r3115W.93
RECEIPT
DATE
BY
DATE FI ALED
INSPECTOR
� �y
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
- _
Ducts _
Return Air
Steel
Combustion Air
Roof Deck
7 - ,33- p (
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing—p/
Compressor
Insulation
6 p
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 boy
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
Waste Lines / 7
Gas Test
Electric Final
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
I
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: