9808-191 (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.
r License # Lic. Class y Exp. Date
JDate Signature of Contractor+
. +flirt a @ % r .1.e t,3
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).
( ) 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.
( 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.
.iVAER CAN 1N.S. CO. UWC.8076030
(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 thoseprovisions. 4 'r +
vDate: ��'' Applicant "'"'2 -y'' : +'L'`•• -t
�r
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 Coderiterest 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 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. r
Zature (Owner/Ag �!{'�- Date
R
PERMIT # CONTROL #
BUILDING PERMIT
DATEj�� fir VALUATION i�,i'•�rp+���� LOT TRACT
2Q,11451
1.41
JOB SITEf '
ADDRE S '9•-1.468! LILA,
�APN 769-ia 0.403
OWNER
CONTRACTOR / DESIGNER / ENGINEER
�KiE1.11IIS RES!DE.Nr rl A , COINT51.1"%UC:T'fGN
5sARK PLJk2Yv ME 4 0
5 PARK PLAZA, SUITE 400
11MNk', t CA 92614
IRVINE CA. 92614
(714f251-61100 f i:f.t4 5072
USE OF PERMIT
S JLrE t'AiF1I Y JVVE'1..lN, t
t"a , 0 - IAft L0174 3 at=zaff DOES NOf INCLUDE BLOCK WAZA, OR.
Cil -10411 CaN TP,'U'_1'sON 3,072 00 SF
PC2RCIII&ATIO 302.110 SI
1ARJVJE/CARI?0TCr 80-7.00 14F
�iyr abYtd�PL�,.Ai'COS OF COi�irS'�•RUC110NI
259,14 2,60
y 1ry(��y�'T p y�yv �,a d'K/.
i1'y9'.`r.f�i(�'8IC A}'.R�.4,o��,YfJtVONIMlY
CO.NS'TRUC'I'IONFEE 101-000-418-000 $2,19.9.5o
"PLAID CITECK FIX 101 -OW -419-313 S9711.43
1b O &NICALS'.EB 101-400-421-000 $98.50
ar n, ICAL FM 101 -000-420-M $206.16
PLIUMB3'NO- 101 -000 -43,1) -thio $M.50
ST.kO ?c arfON FEE - Rr-,SID 1,01•-000-241-000
CR.AWNG IM 101-000-423-000
LP1MA,S RUt' IVRE iE 179% 225-000-413-342 $3,740,34
ART IN P1JR 1C'1?i..ACH3,-1RES1) 701.000.255-000 $397.86
M, DEPOSIT %.Qj-000.4 9-318 475".00
SU4�>Tt 'rAl� f�CJ!hifRil' , rT.JI A.ND P1A- N CHECK,
WWI()
LESS PRE -PAID FEES
4750.00
ra. e
SEP 11.1,998 T06 1, PERMIT r FXS Dis'l, NOW
REC IPT
DATE
Bii
DATE FINALED
INSPECTOR
INSPECTION RECORD
G
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 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
t
Final
Utility Notice (Perm)
COMMENTS:
CITY OF LA QUINTA
• ~ - ``� . rILtj I�'& SAFETY DEPARTMENT.
^'.. 777-7012
IMSPECTION REQUEST LINE
SEP 1; 777-7153
Owr►eF.•�
Contractor
Permit Number agog 191
POST ON J NSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-146 LIG e
SFD - PLAN IA, LOT#3, PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL f/
MAIN GROUND SYSTEM
GROUND PLUMBING 5
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB Z
ELECTRICAL GROUND WORK
DO 140T POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
ROOF (,
BOND BEAM
O.K. TO WRAP 17 qV_
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION jam,
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNEP
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
$EWER SEPTIC TANK
FINALS
ELECTRICAL
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER - 4?i /%
/ 2__I5< Gk),61
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING