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LICENSED CONTRACTOR DECLARATION'
I hereby affirm under penalty of perjury that 'l am licensed under provisions of
Chapter 9 (commencing with Section 7000yof Division 3 of the Business and .r
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date `
143 02 3 1 4
-
Date 44Z:6 r2 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).
( ) 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 fol lowing" declarations:
( ) I have and will maintain a certificate of consent to self,insu,e for workers'
compensation, as provided for by Section 3700 of the If
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. I1
11.21•21.51'L�iV.i .1. 440 b2J. 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 Californ.,ia, and agree that if I should become
subject to the workers' compensation.,Orovisions of Section 3700 of the Labor
Code, I shall forthwith comply with a those llrovisions/
fDate: �i. Applicant R'y Ileif
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 Inspection purposes.
/ , ,rr
Signature (Owner/Agent) r t,i , , Date
BUILDING PERMIT PERMITJ-29z
DATE�� VALUATION S3�� g3�" LOT 14M TRACT �����•
re
f'
JOB SITE
ADDRESS 7!)J54 Cir, TR
APN 7469-W)-0.2,6
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MARVIN HOMES
715-080 CALLii FST A.D0 S ['E 2,01
8-080 C ALL1 ES -VDU 4,M 201
LA QU1'KrA CA. 9,1253
LA QUINITA CA 92233
,70 W -11-2.W1 C OL'if 5407
USE OF PERMIT
SINGLE FAMILY WFLU!,10
F'i.fsN :1A, - 311D - KI.W 1' 7.70,83 NOT I;W E,Wi . fiCU a. MkLL S 0R 3'o0.(.,.
tv9!U)F O.N1 ry AN'S'l—RUSCd"tnii j 'i to' LW
W .r9'.['
Ffe RC:HI>F rio 528.00 8F3fldLt�.CiF;/i
F1.F2.F�tl,tl' 87G.QU SH
CUST OF MNSTRUCTIaN
3431143190
PERMIT ME SUfAi'iMARY
C O STRl3O:'i [ON FEL 101-W)-418-000 1,11,51J.00
Yui,, NN r7111WI 'te•_, RF'li $1,22.3,34
f>'il":Cita1131CAL C'1<E $111.50
CMi'CTRWAL FEE X247.1 G
Y1,iitVlCs1N(9 f''i 1? koI4 O-41941100
.1TRO;NO RRYf ION F FF? - RY810 I W-0110-24
G11ADf•NO, [ V174 1f)1.r1tf0- 3fQt%0 $20.00
11,0TRASMUC'i'URE.isl~E, . 225-000-443-342 S6,000.00
Ai4x IN14JI40"', 6 ew''hS � .I;.I::StC 701-000-255-000
SI IR;T<'1't'A T, MN'S a 1Rl JcT'NCiN AND Pr,AN CH RCTIK
$9,9R i .0 1
LEE .PRE -PATI) FES
1*0.00
TMAI,PI.9IMITS;"MiKSDLI ENOW
$9,981.91
n\ /.
RECEIPT
2c.1
DATE
.N(
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
Sd
Exhaust Fans
O.K to Wrap
- a4,7-,
F.A.U.
Framing
_2
Compressor
Insulation
. Z _
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
.- • �jZf
Final
- u
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Z
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
COMMENTS:
Final ` (�
Utility Notice (Gas) _p -
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 r- - 'Oro AIM --
Utility Notice (Perm) -