9908-129 (SFD)010ENSED C04TRkCTORfDk ECLARATION.
I hereby affirm under penalty of perjury that I �m licensed under pro�vision of
'S"nes,
Chapter 9 (commencing with Section 7000) of Division 3 of the BL S and
Professionals Code, andrny License is in full force an&dfri6t7�'
License,#' Lic. Class Exp.
741�i25 13 1 1�. 1/3W191
co 171111
Signat I ur'e of Contract
OWNER -BUILDER DECLARATION
I hereby affirm under penalty 6f,perlury that I am exempt from the Contractor's
License Law for the following reason:- t � .1
( )- . 1, as owner of the property, or my employees with wages as , their sole
compensation, will do the work, and the structure i's 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 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.
(A I have and will maintai n* 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 insur�nce carrier & policy no. are:
Carrier Policy No.'
(This -section, need not be completed if the permit valuation is for $106.00 or. less);
I certify that in the performance of the work-f6r which this permit is issued,
I shall not,"employ any person in any mann'eer s�a� to becoiAe subject to the
workers" compensation laws of Calif ornia,,arfd agree that if should become
su;2661: to thelworkers' compensation pr6isions b V00-of.th 0 e Labor
d
de I Aall folwith comply with,those proOisions�.,/// -A
6ate:' I I 10 12 Applicant-"" / /-� '� -L"' .
warni� F �ilure to !Secure Workers' Compensation coverage� is unlawful and
shall subject ah employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as pro� ided 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 per6t to cancellati6n.
I certify that I have read this applilation and�state thaYhe above information is
correct. I agree to comply with all City,,6�d State laws relating to the building
construction, and hereby authoriZe' repres rt�th�e S�' of this City to enter upon
the above-mentioned propert7`forjrfspecti7n purposes.
60
L�ignature (Owriber/Agent) Date
PERMIT#
*
BUILDING PERMIT
"IM129
DATE VALUATION LOT I HAL, I
JOB SITd
ADDRESS 79-482 UXAM-0
APN
772-110-946
OWNER
CONTRACTOR / DESIGNER ENGINEER
OrrRUS DEVELOPMEW LLC'
NMARM ITOMES
51-370 AV BERMUDAS, VKH. 1
19-080 CALLE WMAIJO SM
201
LA QU(NTA CA 92253
LA QUiNI-A
CA,
42233
(760)771 .2567
OffiX
507
USE OF PERMIT
SF14TCJ3 PAMI LY DWELLING
SFO -LOT 22, j11.ANZQ,*.. MMUrT D(it-'S NOT 01CMDEBLOCK" WALL
POO.L.
CTISTO.NA MNSTRU MMON 4.697.06 Sr
P01RCH&IATIO, 892.010 SIF
STRUCTRDN
PFIRAHT FC1 f, SUMINIARA,
0-ONSTRUMON FEL 101-M-418-000
KAN 1CT15,XFR_ 1W40439 -34R,
Nll-�CNANICAL TZlt
FAX-CM.ICALM, joi-000-420400 SZ4.02
PLUMBiNG Fla, 3 Zy! - 7.
5'111RONG MMM034 FEE -X FWD 1, 04 4M-241 �000
> _101
GRAD M, 0.�V' 1.0 1 M,A _4213-000
ART FN RUSID 701-600-2M'S-WO S7316.34
n
Dh"VC-LQPE;R rMeAur FIEF
rrl I'D
Ln. .
SRAB-TMAL "'CKFIRU(NION A14D PLAN CHFCK
$6,340,61
LESS PPRE-PAID.FEES
:lrarm. k um rr Ff.,Fs DUC NOW
RECEIPT
DATE
BY
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4 - Z -r,--- n 0
Underground Ducts
Forme& Footings
01
I - 2- C_ 6?" 46e
Ducts
Slab Grade
49-
Return Air
Steel & To, Te
60
Combustion Air
Roof Deck
3—r- 6w-
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
::;Ic/ oe,!K
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
ZY –,,?-C - CA Aoc
Final
Final
BLOCKWALL APPROVALS
POOLS -SPAS
Steel
Set Backs
Electric Bond
FooUnp
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
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
Litility Notice (Perm)
COMMENTS:
1-74— Too–