9809-094 (SFD)LICENSED CONTRACTOR DECLARATION .
I hereby affirm under penalty of perjury that I am licensed under provisions of
;Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
/765444 fi�l�00
ate 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).
( ) 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
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.
'p, (x) 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 ANM♦ AN tN'{ O Policy No. WC
0 /030
(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
subject,to the workers' compensation provisions of Section 3700 of the Labor
Cc
,06 shall forthwith comply with those provisions.
,pfite:�'44 �. 'a Applicant--
-- ''� _• .«,
yy I 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. -r
1.'Each person upon whose behalf this application ismade & each personlat
whose request and for whose benefit work is performed under or pursuanUto
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 1
construction, and hereby authorize representatives of .this City to enter upon
Zthe above-mentioned property for inspection purposes... Ignatu a (Owner/Agent) ` ' <•' �.� P ' �€ _ Date :
BUILDING PERMIT PERMI980,-094 CONTROL#
DATE VALUATION S203,M8.30 LOT 45 TRACT 2181226
SQ1226
JOB SIT 79_JI..1 CET1UN0
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER /ENGINEER
t3P�l...+t�
DE'SERT t. SM f LI
I"r EEL.Lt� i i) SIDE ' LAI X!`i'ks1SIVUr-1`01"
3 PARK PLAZA S � 400
5 PAIM- MIAZ,A, SLIM, , 400
I1tVflgE CA 9261.4
IRVNI L CA 92614
(714)2551-61.00 CBT.#: _5072
USE OFPERMIT
S—INGLE FAWL Y DWq 1NG
S D •• 4Mc?Ur�I..) P�.Aid 2A Ci iRiia/icT"I: R - ! iTt�tTi' .GC�u i�0T
M1,W)E ffi.QCK WAYL OR PCXR,
J
C iS'1`O&ICi.tNSr}ZUCTLL0. IV 2,419.00 Sb
Poilc-H .PAVO 306.00 SF
1, fAKAGF'JCAidFV,RT 579.00 Sly
V!a�6B.AT.6[\.ii'.rW"Mq,:�r:7�Yf 8+�'1..'�ftV.XAtut�JY�R'.Ml6.iV
.4+JJl+P.�aY..l+l
PERMIT FER, 511'J8WIRY
C�t�idS'PRUG1'1t7NFEE 101 -000.418 -WO
P11ANr;'liECK FFR 101 -0.0Q -4'_W-318 S f 7 75
;NINC3 AN1CAL Ir *37, .101-000423.-000 $171121.00
EL VXTj '(,#,4t r-J%7i. $15115
1:'i,C1fV.I13ING 1:'.t; ; 1f)i-Of30-419-f200 3155 a5
S?IZ+ti"irrc tt:i'ct'tint_r.'1?TN-tz 't) :101-f�00,,41.Q $20.19
4I3�%Ui12•fti I' f'.f:r �.()1 "0If0^�9.-',�.11G0 �:�o-et�� .
j.11gFRiWR' it;'!`0R473 i`ETI '25-000-443-342 $4.495.24
ART )N PUBLIC 1111LA.C;Mfs 701 -000 -255 -NO
9-:F7,tr Carf' 103 -0(1t) -x39 -3t8 -'S`.02
P.
�g
R
4
Oka k, CONST ;8:i.1C)N .tANi) 3't,.Ait MEC;K.
$7,01 7.53
i� 343S I -RE-PAID 14FTM
7;0.()0
TOTAL P�RMAT FF WN 1)UE I\!tioil'
:ii � � �Y�-•�.r��
FECFIIPT
DATE
BY
DATE FINALEDINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
— Q
Drywall - Int. Lath
Final
�-
Final lexPOOLS
BLOCKWALL APPROVALS
steel
- SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Corer
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
ASIAHeater
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
Utility Notice (Perm)
COMMENTS:
03/10/1999 17:17 7607714155
r ' f
fr' '
GMC OF LA OUINTA
l� SING & SAFETY DEPARTMENT
- 777.7013
SEp j1,YAPECTION REouc-ST LINE
777.7153
op gwn4.;;�ER'ir HOUSING
Contractor I_AIEL Iic A>F`crjjrNjl A
PWMIt Numbw 980 -094
POST ON 008 IN C NSPICU US PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JM ADDRESS _ 79-525 CETRINO
SFD (MODEL) IA CITRUS/RY'DER - PERMIT
DOES NOT INCLUDE BLOCK WALL OR
ABOVE APPROVALS DO NOT INCLUDE RIGHt m
TURN ON !!THEMES On OCCUPY 00 L DING