SFD (0111-229)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
T
Date S k- f +� Signature Aontractor
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:
CarrierS:1'ATE KYND 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 37001of the Labor
Code, -I shall1forthwith complywith those provisions..-"
Date:,f %-j .' Applicant �y ,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000in
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 employee .
2. Any permit issued as a result of this application becomes null and void
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above information
correct. I agree to comply with all City, and State laws relating to the buildi
construction,, and hereby authorize�epresentatives of this City to enter up,
the above-mentioned pro Cty forinspection purp s' '' �
Signature (Owner/Agent): aP J Date�� * P�
.,.'`x.59,4' G% �•s.,r,..=.... "�
BUILDING PERMIT PERMT#
0111,229
DATE VALUATION LOT TRACT
10,,41 �'
JOB SITE
ADDRESS .i .ff DI
APN
OWrN*qE,�Ry���yi
CONTRAACTC�O•tRy//DESIGNER/ ENGINEER
ppyyo� p fC� t
711).Lrw^.a7.LaF.L
a•�
Y�'Cy'r�C}�'�`?1d�
'�.�-2?r15�.A3'��"`•N't:►:l:��.(l):I.'�i'A�l� .
LA-0,{.e'NTA. CA _W2253
EAQ_cTWrA CA 9225:
(760)771-1941 CaLo 2996
USE OF PERMIT
,SIFID , 1,07 e52 I:'.UN EM PERMIT DOM NOT INCLUDE, HLOC K WA.ULS,
POCIL�SPA OR DRWNWAY APPROACH
PMCf3'Aa.ra.'tTIO .267.90 Ski
t'YAkA 0) dwA F TORT lj'E'
IMMIX 30b"Fr Or' C.01
PIM
COPS 3 RUC"'CION FTM :) 01 Ri*0.4 3 8.000 $1,963,00
PLAN C HWK. 2}`&f
1t` EC':1r�. °�1�1tT.�.'143.a k9?E�F
q1 X0111-000x41.21-f/!��00
.IL XA11.f 6i!✓,4•All:F(i K i0l'4JV6�!'•42V^VJ00
PLUMfl1 40l PER. 101-000-419.000
17EX, • RESID 101-000-241-000
++�yyrF�Rppc�a�cy�//�l�yys.�THYN
/
�.�DA'�ATLYti'ii:?.{'G.LRr l Owl.+!J�• /•`�w V`J D5M,4A5+
0nfZtDPZR JIMP C -T ii`�9:T f,�fii. f30
klittT M 1'Uf3tFIi,1?1:ACKS . RMIr 770-1700.445000 $52.1:3
�y
s.3,728yy.38�
pp��r' 7 pc./ �.
AJESS ,.�.i�.8�+^�i'D�'AA.3t, f 1 3 3
LESS
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DECD 6 2001 -
C81YOFLAQUINTA
PATE
BY _ ,
DAjE FINA IFIIINSP
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�}'-/ -�
Underground Ducts
Forms & Footings
_ 6 _ Z
Ducts
t� _
Slab Grade
2l -
Return Air
(�
Steel
Combustion Air
Roof Deck
- v
Exhaust Fans
O.K. to Wrap
_oZ>
F.A.U.
Framing
3 _d
Compressor
Insulation
' - -_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
_
Fans & Controls
Party Wall Insulation
—
Condensate Lines
Party Wall Firewall
Exterior Lath JA7—
ej -L
'
Drywall - Int. Lath
r/-, ' L
Final
� /3
Final
�? /3 ✓Z
_,7_ _
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines ��
_
_�S
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
fes%_
O.K. for Finish Plaster
Sewer Lateral
v
Pool Cover
Sewer Connection
y�Z q 2—
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
14;7_/1 —
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)