9808-145 (SATT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
License# Lic. Class 'Exp. Date
v3 LOLu
cZ � Date f ' 4f Signature of Contractor -
Z0 0 Ir
U 0 OWNER -BUILDER DECLARATIQ1`4
HWd Irl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
M () I am exempt under Section , B&P.C. for this reason
U')
O N Date Signature of Owner
0)d Z WORKER'S COMPENSATION DECLARATION
< cc I hereby affirm under penalty of perjury one of the following declarations:
H O O 1 have,and will maintain a certificate of consent to self -insure for workers'
K W L= compensation, as provided for by Section 3,700 of the Labor Code, for the
J Q performance of the work for which this permit is issued.
n Q 0 ( ) I have, and will maintain workers' compensation insurance, as required by
j U Q Section 3700 of the Labor Code, for the performance of the work for which this
]: rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
`t Z Carrier Policy No..
Cb5
N C) INTATI.17 FUN[) 0171015
g' (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
subj'ect to thew kers' compensaIIG4rovisions of ection 3700`of the Labor
Cdde, I shfall fortpwith comply with'thos�e provisions.
;,15ate: r:� tt 1,2 eJ Applicant—'
Warning: Failure to secure Workers' Compensation overage 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
i of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety h
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 r
th"'bove-mentioned property for n�_pec tion purposes.
rSignature (Owner/Agent),, Datd
r
BUILDINGPERMIT ° PERMIT# CONTROL#
DATE VALUATION LOT 9tivi 6-1415 TRACT i? 9
'
$164,tso 53 Z; (o
,
G
JOB slyr-
APN
ADDRESS 49-315 C ASI C A DRIVE
b a�38l� dil;�
OWNER
CONTRACTOR / DESIGNER! ENGINEER
Tr% t �c` �E; ' 1 a�rl tJr�ik�.El,�rr
.If.. -i �V' _✓f • 1'.-1
�'1 T�!\.J �\./d - ,��1.-•t-1,2i�i4
A.0, BOX 1716
'79-295 .RJiNCH(,,) LA. Qi -ANT: DR?
LAQ01.W-A CA tr2253
LA,. QI-FINI:i. CA 92253
(7(�()'f771,..J.cra!! Rte.-`-`� `•3!)p -
USE OF PERMIT
0'KIIK- ,t i f
SFA - PLAN A, LOT #':�3, Pfa' 'MiT WES N'OT fNrA.UDI? BLOCK iilALL
OR, POOL. PLAN (Oi 0C I; FES Y6011CTD 79:6 FOR N11.1 .'f'1PLE t831 JANt, E OF
SAME PLAN T Y)YE.
CU3TOMCO-NSTRir`LTION 1,975.00 SF
ti(00 3F
(.fit RkW*FJCAdZTORT 465.041 tiE
ENTIAMATET COST GIF 4ONS" RUIC IONT
AYF9��♦`b �.. �fJ
00N.% fR14 riCiN RM l01-000-4 k84,100 $ri 1.la(f
P1_,AN CHF -CIN, FEE I0.1.000-410.3 I R
NiffiC HANIC:AL FEEL' .101-000-42.1-006 $105.00
ELL-k-1RtC AL F141, 10'1-000-420-600 5135.93
PLUNMIiNC"+Ft E 101.00IO-419.000 65 25
S'llR0N(1 &ICYPTON 3 } }s - RESID 10f -0(M.)-241-(tilf) Iq IF;.5()
(aRrt.DING IT1L 1.0.1.0(N) -<u 4100 �1r7.ti0
I1`fi',tt r134'RUC T1. RC Fla' 241.54j00 .113 3 2
ART IN PIfSUC 'LAA -713 • T�F,�1i:E7i)1-0li(}'2.t�U0ti` $1.62.40
r
PAI&KYrAl, <:ONA'rftLIC"I:'1ON ANL'( PLAN Cxl1'sCK
%3Og.57
LESS PRE AID FEES
MOO
AUG
TO'r'A1, PMRAIF" , FElli.s 6)UR"IN'OW
�.G,.lfrN.ti7
"ATY0
F CEIPT
DATE
BYO s
DATE FINALED
INSPECTOR
as
Y•-
IN�PECTIOO N �ECOO P',D
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
9WLDHG
APPROVALS
MECHAHCAL APPROVALS
Set Backs
Q'
Underground Ducts
Forms & Footings
w- Ci
Ducts
Slab Grade
.
Return Air
Steel
Combustion Air
Roof Deck
40
Exhaust Fans
O.K to Wrap
—
F.A.U.
Framing
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
UG
Final
Zp—
Final °
SL OCKWALL APPROVALS
Steel
POO(L.S - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLURflWNG APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Pipirig
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) "
ELEOT=AL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F1
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: