PAT (0310-109)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 iri full force and effect.;
License # q '[[Lic. Class Exp. Date �q
64 61251 B 'MC f . ,+. � 'U+ aG•�
Date -, "r• (2 3- Signature of Contractor -Ile �•
rw i'�,,
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 9TIAT&FUi4E) Policy No. 044-010018869
(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, provisions,i.. _ '
Date: Applicant'!
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.
f _
Signature (Owner/Agent),Dates<•
BUILDING PERMIT PERMIT#
DATE vVALUATIONLOT TRACT
JOB SITE
'ADDRESS 79-992 M-CSS101 ' AIVE, )?A,Tr
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
TI URZZ. CCT MU'CI.1014
79-982 MISSION DRAT. EAST
74-442ISAROMLA
L.A QTTWA CA 92253
P1+TIA DESER- T CA 92260
(76(()346..6932 CB14 4547
USE OF PERMIT
PA2Ib
972 :SP PATIO cairER'vu mt9Clt m cALCS &,PY_4N.7001 cern
PORCHIPAX10 87 „Oa OF
- gin'i;`atl.`m COSH} Or CONS73niMON
11 �. 7•
PLAN CHECK FK Fr, .101-000439-318. W75
irldl'CJiRUCTILYNFEE 241-1700-411 -0011 14 $1aa.OfP
�
STRC)M MOTION ION i� e,' RESTD J.01 0 Q0.241.000. . 51,16
De
OCT 23.2003
{
CITY OF LA QIIINTA
FINANCE DEPT.
RM-170TA L COk VIRT3C'TION AND PLAN t"BECK
x;223.91
RECEIPT
DATE IK "i
BY'
DATE F NALED ✓
INSPECTOR
.�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 ff
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
Steel
POOLS - SPAS
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
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
FbQures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
.'Final
Utility Notice (Perm)
COMMENTS:.
YOUNG ENGINEERING SERVICES k'
• Engineering • Architecture•Surveying• Building & Safety Services •-
Letter of Transmittal
To: CITY OF LA QUINTA Date: 10/21/2003
Attn: ED RANDALL
Tel #: (760) 777-7012
We are forwarding:
No. of Copies
1
Project: 79-982 MISSION DR. EAST
PC #: 0310-109 (1ST CHECK)
Tract #:
X By Messenger By Mail Your Pickup
Description:
SET OF PLANS
SET OF CALCS '1 J;e-
. v
Est) e,6
Comments: PLANS ARE APPROVABLE.
THANK YOU.
This Material Sent for:
Your Files Per Your Request
Your Review Approval
X Checking At the request of:
Other
By: MARCELL McELROY
Phone #: 760-360-5770 s
77-804 Wildcat Drive, Suite C, Palm Desert, CA 92211 (760) 360-5770
Bronz Young
.I
4