9307-268 (SFD)U) J�c
(V. W
O M
W
rZ
o Z r-
�
OO
H�
J
W W 1l-
F- a
U)
Z
co
Ln
N
ON
U °)
d Q
- O
X W LL
mUU
O
CL: 0)
"t Z_
oob 5
C)
J
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
at Signature of Con tr ~
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.
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.
CrrJl, t N EAGLE MS.NMC154406 00
(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 workggrs' compensation prov ays of Section 3700 of the Labor
Code•hh I fort diith comply with t sevisio s.
�at'ey- Applicant-,L•-�^--
Warning: Failure to secure Workers' Compens Ion 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.
fi
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 x
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 upon
the above-mentioned property for inspectiogrpurposes. C
ySignature (Owner/Age t) / DatP/� -`
PERMIT #- V CONTROLN
BUILDING PERMIT
DATE VALUATION �Sii,�,S� �Q LOT ��� _ � TRACT 73
-//S, �, _/4 � �4 0
/74-055 ASHLEY PLAtE
-
APN 0114-375-009
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Cr�MJP,Y CROWELL CCiN3MtJNMES
GeWLA
1535 SES. -`D" S'1"1tT"E"1", STT 6200
i 535 so.11.01, s"I�'�EEN, ST.i1. #.200
S.F1.N.[#TrI'iNARD1i40 CA 92408
SAN BE;RNA..1tDIN O CA 92408
�9fr'9 3$1-6A0 CBL# 2120
USE OF PERMIT
fiiNGLE 1 AFMTLY DWELLING
603, PLAIttlR. LOT J PF► IMIT W -h$ NO'C INCLUDEBLOCK WADS
OR 1100L. €ALAN CHECK M31Z.EDU RO BY 75% Mt WJ3.MPLE I:SfiW1NCE
OF SAM. -MAX TWE.
TI ACT CON S'1`.RUC`1'TON 1, d$?.iiii �•
PORCUi;"ATIO M.00 SF
0ARAGE7C't1RPOR ' 630.N) Sr
USTIMA, U0 COST OF I 011113TRUCTION
30
0,430.0
PERMIT FEE SUINI.A'1AI V
P1.AN ,Wf C.K. FEF, 101-000-439-318 $115.89
C-. 'y?33TKLTC"f 10N FF -T, 0140-=115-000 $5511.0-0
WILK'HANICAL FT,1; 101-000-421-000 SAV.flt1
EIEC'tIMICAL %U I01 -OW -420-M �1.tA4.bf3
PL.ULMJ31110 PTE 101-000-419-000 $118.00
X1.#?ONONA0710i%1FEE, «.RESTO 101-00)-241-C1t) $8.04
ORtADING T -P,-3 101-000-42-1-000 520.0
tld.MAITMUC:'PLiREFE s ' 225 -00G -443i 342 S"1,'1y8,91
7 3µ irAL LON'�:Ruc'1 ov ANI) P.1 Am C"3�E:E m
+
' ' LE PT�&PAID 1'EES
0.00
SEP` 2 8 1: 0`10
tOTATL, PERMIT �N'D!.RS UE'NOW
#
6 qqg �..
.eD
�. 1• ///fit .
RECEIPT
DATE
DAY FINALE
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms 8 Footings
_ _ _ _
o/
! `�/may
Underground Ducts
Ducts
Slab Grade
-,;zo—
Return Air
Steel
Combustion Air
Roof Deck
_L��o _Q
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 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
Gas Piping
/0=4�p —p _
Encapsulation
Gas Test
/6
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
t
Final
Utility Notice (Perm)
COMMENTS: