9808-190 (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
f s��;+1��F ♦3 1/31i0o
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.
( 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 & poliry nn. are:
Carrier Policy No.
V1W1Rt'Ci4';7 %N.1. co DIvtifC80760300
(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
sub'ect to the workers' compensation provisions of Section 3700 of the Labor
C7e, I shall forthwith comply with those provisions.),
spate: • ,, f;rGY Applicant
4 / f
JF
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 %inteiest 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 g
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, indemnifyt
& 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 withim 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 upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) �`r� ' ;%•:/^ -.-A Date ' x
# CONTROL#
BUILDING PERMIT PERMIT14808-190
DATE VALUATION S321.251.90 LOT 2 TRACT . 2&11.5
JOB SITE` t �sE -7
ADDRESS
PN 7069-WiAN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
5 PARK P1..AM 91T. 400
a PATI�3i' PLAZA, SUM. 400
iftY:lNr✓ CA -42614
IRVINE CA 92,614
j.
(714}25-t-oim CRIt 5072
USE OF PERMIT l-
4S.J.NL.XLC+.i•AM11,X DWZ'iLfS1 NG
SIFDZ - 0R -W, LOTS?? PMeMFf O SS'NOT IMCLUDE Mt3CK WALL Qlk
Pool.
C11 't'Oivi C:iJNSiRi C T.1014 1879.00 Sr.
i'C?XtCWPATiO �, 310.00 3
C:+ARA..061 ;A:lzPOWr. 763.00 SP,
'
1:'1,'r..�.l�:��i� �:��'� t�;".s' L:Q'�Idr,��.:t�7•'.���.
32.l.����..'F91
p� pypq ¢��5t �s
Cy'ON;`TRUG°D",.t3N fi"t, 3 81.416.50
MAN f:'1?D", ME101-000 ��-3iR �t.159,Ri
jNX.0 14LN1CAL Mt0i o0+JM 6.1-000 sa ,.au
t LE1 TMCAL FU 101-000-420.000 $215.03
1'.LUAM 8MG FE, F, 101.000-419-000 5229.25
g'iRONOV-NU ` V RM - MtSM 101.000 -241 -CO 2. 3
110 ••JOq(O�i01-4g7[:ry`1r('00
C�3,F.t��(ljl7N� G Sy}20.►.00
y ��Ms�y /79� yyy�[7 t
.fl6RAS TP,UCi.il.iV.7;E' E 225-0U�J^•44 —342 W�3O W.00
ART M PUBLIC lea -ACES - RE& 709-000-255-000 5553.13
PER D'. k,)SI1 �} ' :lt➢�-00(} 4,. ��.�g� _V50,00
V,POVQ COMM U010N .AM PLAN CREC•°�+'
$9,7-59.9'1
iw 6" LESS Ji �.C4T✓".C�.f ID PIEFIS
4. 150.00
Ig AnT IF ERS DUE NOW
Arik
S9,019.91
t ,
[RECEIPT
DATE
BY
ED
INSPECTOR
C_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
A_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
_
Roof Deck
Exhaust Fans
/ C�
O.K to Wrap
_
F.A.U.
Framing
Insulation
L?
/
Compressor
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 17-2
POOLS - SPAS
BLOCKWALL
APPROVALS
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
�� 9 m a�c
Appliances
Final
COMMENTS:
-Q w/4��' (e 5 47
Final s
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
i
Finalp �i
Utility Notice (Perm)_
a
CITY OF LA QUINTA
,. 77Bulg= lfAfETY DEPARTMENT
777-7012
SEP 1,JN TION REQUEST LINE
777-7153
Owner 1 �4-tl(7SiN(: 11C
Contractor !` A TTi'7 7 iTC DL'CiilL'ATTi A i rnl�rcm
Permit Number 9R(18-190
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS - 79-124 i,TGA
SFD,- PLAN 3CR-G2, LOT#2, PERMIT DOES
NOT INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL �y
MAIN GROUND SYSTEM
GROUND PLUMBING -Z
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB Z $xyle
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
-e v+- .�
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ILROUGH GAS & GAS TEST I y`2 y�irt
v
HEATING & VENT- A/C I I
FIRFPI ArF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGN D
KORYWALL INTERIOR /
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
SEWE SEPTIC TANK J �� .•t/
FINALS
Z ELECTRICAL
PLUMBING
)<FINAL GAS TEST
HEATING - AJC
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING