9912-075 (SFD)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
Prl%ssionals Code, and my License is in full force and effect.
License #Lic. Class Exp, Date
7.59465 022yy820
(
Date ' 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).
( ) I, as owner of the property, am exclusively contracting i 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:
Carver N. Policy No.
1,crT,,1p1 jbV"ea
(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 �1
Date: _ n Applicant I ii.-. o
Warning: Failure to secure Workers' Compensation boverage 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.
1 i
Signature (Owner/Agent)' Date •
PERMIT #
BUILDING PERMITS
•:
DATE t VALUATION S:341,248 411 LOT 17 TRACT 28458-11
ADDRESS ,1 %il-545 NAPL ' . DRIVI
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
[�
t.. Y. . .l.:A! L.r.,. v ii + •+A:e i. u• .
a. :» a. 1�.At �.. w tr 6+ SA rt.+
78-01.5 NAPLES DRJVTti '
78615 NAPLES D.It
LA Oj ff WA CA 92253
L.A QLTINI'A CA 92.253
(760) '7.2-027.2 CBL/€ 5750
USE OF PERMIT
SNOLL FAMILY i)tiV1 J,L NG
VD -PLAN 5.k(RaU14'17:.N°:zWT li: OGS i10T INCLUDE Bi.Oi.''te WALLS 032
F00L.K.AN Ct BUK FW it3:- U(3''Ef3 BY is%,. Uk tYi(fi.`3`it AX, ISSUANCE OF
SAtbir PLAN 't NTE.
IRACT COW37Rr C T ION' 2,*i30e�? aI
po-lb ""rYPIki110 i SF
OtiRA(jFJXA.KK)WY 4490) SF
PERMIT Fflti SUMMARY '
C0N 3`i1tUC'1*100 FUR 101 -OW -418-000 57f36.�0
't,1 4011 (11 !?FICK. f F_R 101-11-03-4 9.318 51.61 98
A9rCtir,a31CA" P�;r 101 -Ono -4:•.-•003
Lt,l;C174CAL FEE 101 -WO -420-000
PLUMBING FEE 101-000-419-000 $140.75
3':f'fZONQ NTOT!gN FE F, -F _1731D 1.01. -OM -241 -(1 O $14.12
(;12AD1'1+ G.F4 E? 101-000-423-000 T11().00
DEV0,0PFR FAV ACT FEE $1.907.0
Affr i -N! PUBLIC.PLACES - XESa:C 701.-00x3-255-000
SaJWlMAL CONS*E'RIX.rT,0NAND PLAN CHECK
$3,334.95
LESS PRE- AU) FEES
$0.00
T017A.A., PF RISVn Vr_# X'S tyUF.;NOW
$3,334,95
RECEIPT,_
DATE
BY ! dw
DATE FINALED
INSPECTOR
r
f
INSPECTION RECORD
OPERATION
T'
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
i
MECHANICAL APPROVALS
Set Backs I
Forms & Footings I �i2��
Underground Ducts
Ducts
Slab Grade ; .-Z---opAK 4=1=
Return Air 1000,
Steel I
Combustion Air
Roof Deck }
Exhaust Fans
O.K. to Wrap d
F.A.U.
Framing { — -o-d
Compressor
Insulation { /P, pa
Vents
Fireplace P.L. I
Grills 110,
Fireplace T.O. d
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath I
Drywall - Int. Lath S
f
I
-
[
Final d
Final t -- =-
POOLS - SPAS
B,LOCKWALL APPROVALS _
Steel
Set Backs I
Electric Bond
Footings (
Main Drain
Bond Beam d
Approval to Cover
I
Equipment Location
d
Underground Electric
I
Underground Plbg. Test
Final i
Gas Piping
PLUMBING APPROVALS
3
Gas Test
Electric Final
Waste Lines I , /
Heater Final
Water Piping 1
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans }
O.K. for Finish Plaster
Sewer Lateral }
Pool Cover
Sewer Connection I "-
Encapsulation
Gas Piping }
Gas Test { �J
Appliances d -
I
Final
COMMENTS:
I
Final }
Utility Notice (Gas)
ELECTRICAL
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring }
Law Voltage Wiring
Fixtures I
Main Service I loor
Sub Panels I
Exterior Receptacles
G.F.I. }
Smoke Detectors i
Temp. Use of Power
i
{
Final 1
Utility Notice (Perm) -p0 I N