9811-015 (SFD)U)
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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
1. VW99
ate *r� f 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 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.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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.
STXM i`TN ID T4:311 M-93
(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.. '
date: / A Applicant 4 ./llf� 1
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 aboiie-mentioned property for,inspection purposes.
(gnature (Owner/Agent) %Y- Date
!y
BUILDING PERMIT PERMIT#
9ni.1-IIS
DATE ` VALUATION "41,4,33 3.90 LOT ; TRACT L I—k 98-277
II
JOB Sit Cdr
ADDRESS M` rip-dI`3� 1 a�>� Aw1�4�
APN��-�-O.E9
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CITTWS DEVELOPNtl;;v"!' LI.0
NTAitt' N I3OMES
513722 A VENIDA BERMUDAS S"i,`i? 1 .
7R-0RO C ALLE ES"1`A00, 2'N I7FLOOR
LA QU I -A. C—A 92253
LA QUIWPA• C.A. 92253
fi%a37'71-Zgb'� QUM 5407
USE OF PERMIT <
PLAN 3A11- SM - MCMIT MMS -N OT NC,LIJIM RLO C..k;. WALL's t?s-C
POOL. PLAN MXR. VVB RX --1 fC:W 7'-i FOR M(X TLPL1.:, I''` UA:fd+_':'E OF
' SA.ME F'1..A3'L 'A yPs.
CUSTOM i,0119S T.RUIC 10114 4;151..(1tf uF
1 fftllik'.A.:ftCt 528.00 Sr
GA12AOFJC•ARPORT 876.00 99
LVIA 0. .D CCO).J.tl` 10%F .ti i7T�.7.4.Y1IJM4 . 01N
u -3,.s1.).90
�;+ j� `7'�+ y y' �5jY q7�,g �y,p ,� �Y�b`.n.N�e
CCYNSTRUG"i CIN FEF 101-000-418-000 S1,511-00
PLAN CT4FCI: ;, HE 1 {?;-dtE1�••d34-3 0 �i �?rl� �;a.
tC"&lk`zI�Il1�:PJ_ PD '01,43 ,40
'CLE s iCiV., F -C8 S24,11. 16
%�L(lIv.FFl1TTt31`'Et 101-M-419-000 $'2A3.25
01ARP►CJ1NO,' 'FIE0 101-1,4}Q 1? 3- $2L►.00
11 t �c; i'tctic 1,�tl; l' r 225-0W443-342 443-342 96.000.00
ART iN PUB.L'IC 1,4LAC`1":8 - RESII 701-0200.-255.000 $620.€13
P
' LESS PRE -.PAID FEES
$0.00
NOV 3 0 1998
S9,064.41
RFY Q3" L?'A r
RECEIPT
DATE
By `
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
- ',Z-
Return Air
Steel
Combustion Air
Roof Deck
�.
Exhaust Fans
O.K to Wrap-
/5r
F.A.U.
Framing
. �-
Compressor
Insulation
L' - G
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 S -
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 APPROVALS
Gas Test .
Electric Final
Waste Lines
12K(f—
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer LateralPool
Cover
Sewer Connection
Encapsulation .
Gas Piping
Gas Test
Appliances
Final
Final
Utiln Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
UU14 Notice (Perm) - -
COMMENTS: