9606-148 (BLDG)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty bf perjury that I am licensed under provisions of
f: hapter 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
63408 [ B 1131
It Zate/, /A 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:
(' ) 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).
( ) 1, 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.
qV)'rl have and will maintain workers' compensation insurance, as required by
Sec -03n 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 STA:PI NL7No Policy No. 221-�6..140
(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
CoAfr shall forthwith comply with those provisions.
Ate: 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 j
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 Zove-mentioned property for inspection purposes.
ignature (Owner/Agent) �^ "tel s1� / Date
BUILDING -PERMIT PERM' T�606-148 CONTROL#
3 5 8'8
DATE 6/26196 VALUATION 51750,00 LOT TRACT
JOB SITE 51. 780.tiVENIDA P 01tALES
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
P'SQUIVI,:M. CORONEL
CORONIEL CONS'i`kUC TIf7•N .
P.O. BOX
179-46 ,AVENIDA WNI'U?U[U A ,f
GA, C;tCr(N .A CA. 92233
LA Q(Jft n'A C.A 92253
619564-404
(619)-%4-4604 C:OL0 2-1,01
USE OF PERMIT
13(> F'x'. OC' 2 F" 1'. R f'A [N[N(4 W AT.L - W ') at 1'CPIVRE h .F'I' GAR.r)frA WALL.'
C141 -specs .
6 VI% WALL (,tr
CSTINIATEM +�'iAT OF %:l.►PISMUCI' ON
31750M
4 ER11i9.l1'!' PER. SRMIMA'lf Y
SUla=1rY1'AL CONST AN% #ILAN CHECK
S61-00
LF SS MR -PAID FEES
0.00
f O
'Zrz
D T+ T,1101J PE9tMIT I+'.EVN I)TTE NOW
!fit►3,4#fi
JUN 2.6 1996
BY
RECEIPT
D
BY �1,
DATE FINALED
INSPECTOR
v�j
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drvwall _ Int I ath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
Final I I
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Shower Pans
Equipment Location
Sewer Lateral
Undercround Electric
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
Notice (Gas)
ELECTRICAL APPROVALS
Power Pole
around Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temo. Use of Power
Notice
Final
COMMENTS:
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