9706-024 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
l3
1213 1 A) 7
Date I X-' r Signature -6f 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 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 Policy No.
&rAnr:I Nr) Q63-55%
(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 shalljfoowith comply with those provisions.
Date: %
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 inspections purposes.
Si nature (Owner 4 ent) •! Date % `
PERMIT # CONTROL #
BUILDING PERMIT
9711f►(124 98
DATE 614197 VALUATION $161,1'%6 Xo LOT e«TRACT J1.9
ADDRESS 78-GRO NAVIA;S DkIVE JOB SITE
APN 60q-Ii8(i-01.3
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T11: E�XCllttr:GE. "ARQUI ', INC'
ROGEP, :,ri; t,1,E*.T3E�.cE1; & ASSOC.
11:1,f RENT INA OR
alt -965 BOARDWALK, , SUITE 21'2
RANC110 AIIRA�. E CA 92270
PAI,A11 DESERT CA 92211
(760)777-7756 C rIl.ff 18%.
USE OF PERMIT
5140
WO O I.S.4 22 PLAN 6AR
TRACT C0N37RU�,TION p730.00 SI%
PORCHIPATIO 90.00 St:
GARA0 Jt_".AR1"RT N118.0 8F
I+:STi141ATED M'OS'T o CONS'I'RUC:IION'
1111.151,.30
PC114MIT FE ti!!10MAKY
f_CJN.V'RUC-110N FIFES 101.000-418.000 $856.50
PLAN CfIUCK I-FEr 101-01V-43`�-318 3715.90
;`UiC1W41CAL F13-1 101-000-421-{31)0 $92.011
Ifl.ECTRIC.'AL FI1's 101 -V00 -420-W $156.01
FILUM RIW-1 FIX 101-000-4194W 5166011
8!Yw(3 ntnrio N 1rf�? , RI?310 KII-OM-241-000 316.12
(AWANG FIX' 101-000-1123.000 S20,v0
INVRA.STHU(."'11JI(h FE6 225 -OW -4,11,-342 13,599.1��
ART IN 111JULIC, PLA(13.5. RC.I3fv'101-WO-2;5-000 $152.89
PPi4 J13-` 1(YrAL C-0N',1`ItUC-n0N AND PLAN cit IUCK
%5,774.5?
LESS PRI, -PAID FEES
$000
AUL O1 1997 1
TOTAII, PERMIT FEKSi DI1R NOW
;55,77#.52
(31 -Ty
RECEIPT
DATE
BY !
DATE FINALED
INSPECTOR
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 /1 pj
Compressor
Insulation
Vents
Fireplace P.L. — �l�
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
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 APPR VALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans A
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
U lily Notice (Perm).117711
COMMENTS: