9907-384 (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
637252 8 0 91201
Date Signature of Contractor �7 f p
C/V I J, - %/%2
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
Seddon 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 �^� 4� �,� t ry s -s Policy No. t+7� „
1\OY , INS, CO. l!L- i j' L� k- W!
(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 FOO of the Labor
Code, I shall forthwith comply with those prey
Date: t J Applican/Z
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal. penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to,'&'shall, indemnify
-A hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days, will subject permit to cancellation.
I certify that I have read this application and state.that the above information is
correct. I agree to comply with all City, and°State laws relating to the building
construction, and hereby authorize representativespf this City to enter upon
the above-mentioned property for inspe tion purpo es.
r
Signature (Owner/Agent)4DateI9,9
BUILDING PERMIT PERMIT#
'l'anl"i-e14#4
DATE VALUATION 5.2771'022,.''So LOT 10 TRACT 2-W90-6
JOB SITS+V I9-`34 �...IGA
ADDRESS
APN -769-680-010
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ilt2C`'i'17TY-IIl1ICaiATf'Y i t .^
.I ',Laa/.,Jr.)TTr ilR+a..
A-
I'`r'l.? :f i +l IS'ZrL'II\!.`AI"fTpt r, ltao-` TINTO
A.. .F,n i.luajl.! 11 �.lJLAJ ��L�! ofL/J l: aJIYUB.� Ll v6s
5.PARK PLAZA !UE 400
5 PARK PLAY -A. SUITE 400
11kVLNL CA 9261.4.
IRVINE CA 9:614
'
(94'91r25 1 -6 100 C1111.0 5072
USE OF PERMIT y ,
SING -LE FAMILY � �1 au.I-tvd
SFD - LOT 10 PL W 2AR. I'O2iV4lA DOES. _140T
Cb ST, At co NS'iRUCT10i4 3.328.000 SF
l'%tRt"'f�PA TO'• 3][2,00 SF
f�trl.EiAtY1 iC�iki'(rEZ'f' 695.(N) SF
. r..-l�f+:3 ,! \�it ��..`UL��71'a X, �Y..$'1Bi.1��/��
d1„ t �,��di�.. .<➢!1
�7n.1g ��Ce y�j�{{g7����y '•.IL:taD�0.'I(jb.0.l�.tL
K AU R? ��� U ,1� U.L��MJ.V ARV
KRAUT
t;GNS"1Rue ':VIONFEE 01-•0100--418-000 SL262.50
j`T,AN'f; Tf*,'KF a", 4114-Qtljj-6i� {j3t 1 ¢9 rt,(y�
MECITAMCA1. S* 11014001-421-000 `1a.Of
l-,i;L''" WC:AL HE 1.01^•0110-420-600 ti +ki.t3tS
11LVil4B1N0 FEE 10A -000-e419-000 �.Et16.5tt
8`>i`fiONG IVIG ('IqN ",T, - RIF3 ? 10 j -000-241-N* $27 70
0.1t, .DiNC FIS 101-000-/421-0000
F? IVEHi.UAM MIPAC`i :Fief'. ` a . ' a 4; iit3?.00
A r m PUBLIC PLiN ES - RB810 701-000-25MOO
803�Tt,Yf"t1t�'.'.�1°i'¢'4I.SC°'t�.)?V;�Iii� �1tV (1?ii'
�5�jfi9,l17
!aTAL PERMIT )!'.CFS DOE NOW
S5.169.17
4 E l w)
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE'
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
C.C/
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
CK to Wrap
Framing
dl C/11 G
�Gf O
F.A.U.
Compressor
_
_
- Insulation
_�_���
Vents
Fireplace P.L.
_
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Q
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS T SPAS _
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
a
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final 7 , 7G" Z;J
Utility Notice (Gas) c
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 C - w
Utility Notice (Perm)
COMMENTS: