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LICENSED COKTRACT&R 6ECC4kAfIOk
I hereby affirm under penalty of perjury*that I am licensed under provisions of
Chapter 9 (cor;*nencing with Section 7000) of Division 3 of the Business and
Professionals 'Lode, and my License is in full force and effect.
License # Lic. Class Exp. Date
C33 101351/90
'_�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:
( ) 1, 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
perfo.mance of the work for which this permit is issued.
,- -) I ha�e 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 WWohers' compensation insurance c rh&991�&W. no. are:
Carrier Policy No,
(This section need not be completed if the permit'valuation is for -$100.00 or les�).
I certify that in the performance of the tk for which this permit is issued,
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I shall not employ any person in any manner so as to become sub ect to the
I
workers' compensation laws of Californii4nd agreeZthat if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, l,shall forthwith comply with those'provision
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 pers6n 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 o,f, t 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.
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I certify that I have read this applic(ation and state hat the above information is
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correct. I agree to comply with a . 111 # City,fpnd,state laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
A.. # .� d I It
the above-mentioned property for inspection purposes.
�gnature (Owner/Agent)./"0 W-1 1/i ate C/ ko�/�
PERMIT # CONTROL#
BUILDING PERMIT 9(01-, 117J 4153
DATE 9124196 VALUATION $1%00#.4)J) LOT TRACT
JOB SITE APN
ADDRESS 86-020 CEDAR CRUST --?61-49JXP12
OWNER CONTRACTOR / DESIGNER ENGINEER
WAR f-1 MEYER CALIVOKNIA IWIS 41�� SIPAIS ,
80020 CEDAk CUST .41910 BOARDWAIk NA2
4A QUINI -A C-111 MY% PALM OPSEV CA 92260
(09W.0-9000 CIAI.H 355
USE OF PERMIT
PDX, ANIVOR SPA
1'1001, ANI) SPA ONLY
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COST OF M11*4STRUCITION
PE XMITIPYRSUMMARY
Pi. AN CHRO 9 F FP-, S70.0%
coNsirritucrION
'MP.01AM CAL $24.66
fif�,'F(1'11AWAL 170-1 - P001, 101-000-420-000 $450)
PIAA4R] NO FM� - - 11001. 401AW-419-OW (H)
SUB -TOTAL CONMUC!IRON AND PLAN CHECK $299.05
L '3S M, TS
R, C -PAID Fr $0.00
T VE
T017AL PERMI. lf�% OVE NOW S289105
RECJP�T, BYA,_ c
DATE FINALE D INSPE TOR
DATE
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATETINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Bacl(,'�
Underground Ducts
F,,�Ms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
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
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover 1A I-,
Equipment Location
Underground Electric
I I
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
Fbdures
Main Service
Sub Panels
E)derior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Litility Notice (Perm)
COMMENTS: