9905-193 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
�r_ Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 U)
W Professionals Code, and my License is in full force and effect.
P License # Lic. Class E�p. Date
r– Cy Lo I,/
1 743,015 B 1 I/W 19!
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Z [Date Signature of Contracto A Y, (Z
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CID
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(D OWNER -BUILDER DECLARATION
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W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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
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).
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LO l.am'exempt under Section —, B&P.C. for this reason
C\J Date Signature of Owner
0 C\I A.,
< WORKER'S COMPENSATION DECLARATION
Z
111 1 hereby affirm under penalty of perjury one of the following declarations:
0 1 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
J :3 performance of the work for which this permit is issued.
J
I have and will maintain workers' compensation insurance, as required by
AcTion 3700 of the Labor Code, for the performance of the work for which this
Z permit is issued. My workers' compensation insurance carrier & policy no'. are:
— dirrier Policy No:
Z) :T.r AT E F1JND 14 4 0 125 -.9� 40,
(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 CalifornG', and agree't'hat if I should become
Subject to the workers' compensation, provisions �of 6ection 3700 of the Labor
Code,'l shall forthwith comply with th6ge 6rovisi6ns /ZZ
Date: Annlirqnt
/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.] agree to comply with all Ci�y, and State laws relating to the building
cohstruction, and hereby authorize reipresentatives of this City to enter upon
/ . y
the above-mentioned property for inspection- purposes.
Signature (Owner/Agent) Date
V
iv
PERMIT #
BUILDING PERMIT
"05-193
DATE VALUATION $3Z5,237.40 LOT 30 TRACT LLA97-255
JOBISITE�- 1
ADDRESS 79-405 CETRINO
7
OWNER
CONTRACTOR / DESIGNER / ENGINEER
NIPJWIN UIONIES
MARVIN HOMES
78-0SO CALIX ESTADO S413 20(
78-0130 CALLE LSTADO STE 20.1
LA QUINTA. CA 92253
LA QUINTA CA 92253
(76k)7714.%7 CBL# .5407
USE OF PERMIT
,�INCJLE FAMILY WRUNG
SVP -PLAN tAR. LOT30, - PFiRhff rDOESNOT INCLUDE BLOCK
WALLS C)R PCK)L. P1, AN CHFCK PORTION OF FK9 REDUCFD 75% FOR
MLJLT9'%EI3',A1ANCF OF SAME PLANTYPR PIXURLLA '997-255
CUSTGM CON83TRUCTION 3.860.00 St
P0RaJJPXV10 774.00V
GAAAQFJCAKK,)RT 727.00 8F
FWINATE, 1) COST OF CONSTRUCTION
325.23-7.40
PERhUT FEE SUN01.1-Ally
CONSTRUC-11Q14 FEB 101-000-418-000 S1.430.50
PLAN CHYXX, 17693 M; -W-430-303 $N4,11.93
INIECVANICAL f= 101-000-421-000 $124.00
EL13CU(CAL FIX 10140420.4W $2A.1. 14
PLUM8040 FRE 101 -OW -419-000 $214.50
qlltONC $12.52
, , , M07f ON'F - R FS 19 1411-000-2414V
quAvyNcruc tol-000-V3-000
JNFPuV'4TkUCTM6 rQ 225-000443-342 M*6.00
ART IN P`U`.01JC PLACES - 10ISIC701-000-251-WO $563.09
.z
SUM-TOTAJ, CUN9MUCTION AND PLAN CRECK
LESS PRE-VAJDFEES
$0.00
TOTAL PfRMIT
U,917.68
RECEIPT
DATE
___I
("i �
BY 7_
DATE FINALED
JINSPECTOR
J
;I
INSPECTION RECORD
OPERATION I
DATE
I INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
SetBacks
Underground Ducts
Forms & Footings
L? Z�9[
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
17 ":t
I
Exhaust Fans
O.K to Wrap
2- F
F.A.U.
Framing
Z_ — C', 11Z
Compressor
Insulation
e�Z,2 7--E 4F
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
ShowerPans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final �2
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
Utility Notice (Perm)—
COMMENTS: