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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 Codejand my License is in full force and effect.
License # •, Lic. Class Exp. Date E
723424 i3 i/3.i /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.
jj(y) 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.
AJ'�11: �:t3CAN lJ4'3. C01 DWC30760300
(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
Code, shall forthwith comply with those provisiops. r`}`
11,
vDate: 2/.";Y, Applicant. . �-^',
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety p
for a permit subject to the conditions and restrictions set forth on hisa.)
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant4o
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building.
construction, and hereby authorize representatives of this City to enter upoW'.
therabove-mentioned property for inspection' purposes..
/Signature (Owner/Agent),-� �� -f-` � Date/
BUILDING PERMIT PERMITy� waq-5 CONTROL#
DATE VALUATION S41106.887.30 LOT 44 TRACT 28-227
!�
JOB SITE
79.53- �•�. Y AILNd�
APN'769-470-02.8
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
CNITL vS RESIDE:�"x`if'�
3 PARR PLAZA S 1 X; 400
5 R&R.li. PLt1ZA, Si.1f E 4id)
IitV1NE, CA. 92014
IRVINE CA 926.14
(7f.Rj7$;.isl(?f) CBJX 5072
USE OF PERMIT
4 O - to 0D'h": j PLAN 213 - Cri;.R:U3!£iYDE—li - €?U2i 41T 1 OGS NOT
RNCLUI?lyHL0CX WALL O.R:k'001-
0JS'9 0,N% CEJ Nn1 iRUi~. 1)ON 2,458'.W S
i''ti.t?CWPA',t`IO 267.00 5.1:
UA1t.A<<<WCARKDW ' € 05.00 SF
:BST)Pd, ATE:) C0.1CJ' 0fr CONI "I'i3IIC'T10.
2F. a,S87.31)
,[C$gFF �p5-yrpv '�'tY7,y,gg,Q
PE-JlaMIT FET, A7YJ'1,'.1f..A�.f.:I�►fA.V
PE-JI
E101+I$iiZU%S 1C�i� 10? -000-4.18-000 �1!11.a.r10
PGMN Ct[►,CK Flies SP27 a.'1
y'fLCR`4ANT ICAL1*iii? 10.1.000-42:1-000 392.0
FELECT3MNL rM. 101-000-420-000 $1.35.63
FILLTZBtNo FRE 10.1-000-d 1-000
s.^�'i9`; ONO Ni TOO rION' �'>� � 1<eESID 101-01�0�ff?� -)41-000.? 69
�
s3��
INFRAS'T:di'!'lls`TUCtL'^ 1;'.EE 2,25-0W- 443-342 $4,31115.06
a RI' TN E' i)13LIC.PLA,JL8 - RESW 701-000-155:000 6rj%7.2:
-
Ei D1PCSI"r IM -000-439-3113 4750.00
t
2 r
? ra�fCONS14ILCTIO;v ANn PLAN r;KC°«.
SEP i9gS LESS PRE -PAW FEES
4750.00
t'(YrAll PP11 101Iu .fill aS In Ili 1d NOW
.�1 0FILJA'A
RECEIPT
DATE tit
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
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
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 Pbg. Test -
Final
Gas Piping
PLUMBING APPROVALS .
Gas Test
Electric Final
Waste Lines 2
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
Utility Notice (Perm)
COMMENTS:
CITRUS COURSE LQ PAGE 02
CITY ,OF LA QUINTA
SAFETY DEPARTMENT
M-7012
L .s - "'-1 2 '� PECTION REQUEST LINE
` 777-7153
owil
Contractor-- TE'l 1, S ESMENTI A r --C.ONST
Permit NumbAr2809-095
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-535 CETRINO
SP'D (MODEL) PLAN 2B - CITRUS/RYDER.
PERMIT DOES NOT INCLUDE BLOCK
ripE ��INSPECTION - —
DATE INSP.
FOUNDATION d SETBACK
FOOTING STEEL
0
MAIN GROUND SYSTEM
QROUND PLUMBING
PRE-GUNITE
00 NOT POUR CONCRETE UNTIL ALL ABOVE NAS BEEN SIL%NE
CONCRETE SLAB
d GIRDER
Q
ELECTRICAL GROUND WORK
00 NOT POUR CONCRETE UNTIL ALL ABOVE= HAS BEEN Sit ,SNE
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS, d GAS TEST
HEATING d VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT 0 4' O S'
PRE -ROOF 1 1
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR .! ;
EXTERIOR LATH ar �J r� ror s'Gf'v
1.1
FINALS
PLUMBING
FINAL GAS TEST
HEATING - AIC
HOUSE NUMBERS