9905-192 (SFD)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
l'—, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14. CO
,Uj Professionals Code, and my License is in full force and effect.
co License # Lic. Class Exp Date
LO
LU 743023 b
Z r— Date Signature of Contractor
0. V
r— F= CD OWNER -BUILDER DECLARATION
LLJ I hereby affirm'under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
z 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
s .(Sec. 7044, Business & Professionals Code).
ale
1, as owner of the property, -am exclusively contractir�g with licensed
Contractors to. construct the, project (Sec. 7044, Business & Professionals
Code).
co I am exempt under Section
Ul) B&P.C. for this reason
C\J Date, Signature of Owner
C\I
WORKER'S COMPENSATION DECLARATION
Z
CC, I hereby affirm under penalty of perjury one of the following declarations:
Lo, <
0 1 have and will maintain a certificate of consent to self -insure for workers'
X W�_ compensation, as provided for by Section 3700 of the Labor Code, for the
n__J _J
00 _J , < performance of the work for which this permit is issued.
< I have and will maintain workers' compensation insurance, as required by
Sebtion 3700 of the Labor Code, for the performance of the work for which this
d 1. <
I:L LO P; Sued. 1�y workers' compensation insurance carrier & policy no. are:
0) permit is is
N't z Carrier Policy No.
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< (This section need not be completed if the permit valuation is for $100.00 or le�s).
(.. ) .1 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 th ' at '.if I should become
subject to.the workers' compensation provi'6ns of Section 3700 of the Labor
Code, I shall forthwith comply with those provisionq,.,�
Date: <: Applicant
VWarn.ing: Failure to secure Workers' Compensatiop 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 1. �ach person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
ahj 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 6ertify 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 authorizd representatives of this City to enter upon
'6ses.
the above-mentioned property f&,,inspection,purp
Signature (Owner/Agent) Date
PERMIT #
BUILDING PERMIT
"05-192
DATE VALUATION &VI 5 ,2j7.40 LOT 17 TRACT UA 97-255
7013 ilTE
ADDRESS 79-402 C17-141NO
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MARVIN HONIF�S
MARVINHOMES
78-080 CMIR ESTADO STE 201
78-080 CALLE ESTADO STE 201
L A QXTIMr.A. CA M5)
LA QUIVI-A. CA, W2253
(760)771.2507 C131M 5407
USE OF PERMIT
GLE FAMILY DWELLING
SFD - PLAN 1A, LOT 17, - PERW f Cr)FS NOT 114CLODE BLCK,,K WALLS
OR POOL. PE11 LL A. #97-255
CUS-TO&I CONSTRUMON '�,860.00 SF
PORCIVIATIO 774.00 SW
QARA06iCAJ(P0R:r 727.003F
�EWTIAIATEP COST OF CMISTRItiMON
325,237.40
PLAN C%T_QCX 1TF,
R74 10.1-000421-000
LLM�'IWCAL PEE 101-000-420-000 $24. 1. i4
10'.Wi7ff C,)W �,TF - R.R S 10 101, 1-2M4100
(IN I M $32.52
RIM) [N G F !Z E, 1011MO-423-000 $20.00
XNFRWf1C(JC3URJ,'-. FRE' 225-000-443-342 KOW,00
ART W 1AJLkL IC PLACES - RESAU 770 1 -000-2 5 5-000 150.09
StAIII-10TA.t. C(.'ftN-TR13'C"T1QW AW) PL -AN CHECK
LM PRE -PAID FEES
$0,00
'RYM, P1.1,RMIT FE"k,'I'S DUENOW
$9,793.47
RECEIPT./
DATE
BY.�(,
DATE FINALED
NSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION ____F
DATE
TINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K to Wrap
C) let
F.A.U.
Framing
z 0-
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
Equipment Location
Underground Electric
Underground PIbg. 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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 5p 4?1/
Utility Notice (Perm) Z-:::
COMMENTS: