9811-014 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section -7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
�
7430"2.1 % j J 100;199
ZO t-- Pte f—� Signature of Contractor
V
J U C:) OWNER -BUILDER DECLARATION
WWW r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
ro 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).
( ) 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
LO
N Date Signature of Owner
O�
d Q WORKER'S COMPENSATION DECLARATION
CEI hereby affirm under penalty of perjury one of the following declarations:
FZO () 1 have and will maintain a certificate of consent to self insure for workers'
< W l= compensation, as provided for by Section 3700 of the Labor Code, for the
nJ Q performance of the work for which this permit is issued.
Q U (y) I have and will maintain workers' compensation insurance, as required by
U Q Section 3700 of the Labor Code, for the performance of the work for which this
L Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carter Policy No.
cb l'r rr-_ FUND 11140125-`d;.',
J (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code I shall forthwith comply with those provisions./
,pate: Applicant �� , 2' 4/ �f
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,!nspection purposes.
Sgnature (Owner/Agent) *f_:+/*r� Date
I
BUILDING PERMIT PERMIT#
4811-llis
DATE VALUATION 3318,31 4JO LOT 7 (34) TRACT LLA 97.255
JOB Sh, ADDRESS > 17,91 -MI t,ETRItNO
APN 70-G6"16
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Cl tittis DE. %TL,()P%. Vt1r3'
5I.3iu AV814iDik BERMUDAS S%E 1
;8.090 CALM ESTADO, 2ND FLOOR
LA QUINTA CA 92253
LA QUINl'A. C*A 92253
(7601771-2567 ("11I,f# 1407
USE OF PERMIT
SINGLE PAMILS 0WELIANQ
ULAN R - SFU - DOES NOT 1Nl:Y.i,3371; t3i,oi;.f>; 6Vki: o Olt
.G .PITR&HT
IN -K& PLAN CHECK FER1W)UCED 7.5% FOR A R �
SANTE PLAN 'f`ME.
%ua'.i 0:41 C ONSTRUC _41014 3,"" e.00 SF
NUV 110
K_I1RC11/PXfio 774.1'10 St~
QY 1.. '' �` 7 f•
(3ARA0il/CA32PORT 727.110 tip
a=
i
ES"e Ie�i'�<lATED CtAST OF CVl''S w UCTI N
3 S11gX47? i4.JiV
CONS'ITtUC TLON FEE 1,01-000419.000 1,413(1.00
t,l,aiq C.Fltr(i.' frf1()1-(i()fl-&�y--Ai)2 $?R7.fti
s�tliC +1�1tdICAi. I'i1: )Q1-Q00•��i21 �taQQ fi i�i.(3(3
'
JILL IIRICAJ, Fr% 101,_00)-aa0-Wo S<:415.03
P1,11fvfitINO YHE 1014100-41909) 52141. S0
;'-TRONO AR YfFON tZ 1ZFSltI $(11-000( 141-(W 531.97%
ORAY)fNO1r.1L1 RAAW-123-000 "}vflf)
LIN RASTK.UCT(lk I Fliti 225-0W-441-342 S6,6(0,0V
ARTIN PALIHI tC; i'IJ10-318 - RJESW 701-000-245-01V 5_545.76
€`
StI3 -ii Pa(. is 0N'. ftt.K.'110N AND PLAN CHECK
$8,867,$8,8677 44�
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i.T:;
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
OX to Wrap
G CG
F.A.U.
Framing
Compressor
Insulation
i ®
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
4
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 Pbg. Test
Final
Gas Piping
PLUMBING
APPROVALS
Gas Test
Electric Final
Waste Lines
c — 01
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover .
Sewer Connection
7 7
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL
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
Utility Notice (Perm)
APPROVALS
COMMENTS: