9903-305 (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
' /'0"37252 8 1
D e � Signature of Contractor -' t
/
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).
O I am exempt under Section , B&P.0 ?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.
(This section need not ROVAI 114q.e completed if the permit valuation Is or 00.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
j, 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, I shall forthwith comply with those provisions.
Dat : , i Applicant f '
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 r
any permit issued as a result of this applicaton agrees to, & shall, indemnify
i,.& 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 certity thatI 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. }
Sigpature (Owner/Agent) ,• Date ! h %!
BUILDING PERMIT PERMIT#
DATEVALUATION LOT '1 03.,31)5 TRACT
_ lit' 8287.342.44) 44 `2.1890-6
JOB SITE
APN
ADDRESS
79-5117 1,111A
764-71110-624
OWNER CONTRACTOR / DESIGNER / ENGINEER
DESERT HOUSING LLC CATELLUS .RESIDEDMAL CO7MA1U MES,
5 DARK, PLAZA SITE 400 5 PARK, PLAZA., SUITE 400
TRVINTE CA 92514 IMNE CA 92614
(9 49)2fi1.6100 CBLO 5-072
USE OF PERMIT
SM. L01*44 , PLAN ICR-G I POWTT DOES SOT INCUTO -LOCK
W ALL..OR POOL.
t
CIJS OM.CONS'i.'RU riON 3,43,11.00 SF �
PORCTI/PAMIO 302.ilW STS
GARAG /f,APPORT 807.00 $P ,
EST1 MA:r D COS'1 OF CONSTRUC' ION
287,342.40
1'HiltMIT 1+"EE SUMMLAiRY
CONS R:UCTIU3NFER, 101-000-41.8-000 $1,299.5{1
PLAN 0ffEC:F:, h8 1014000-139-318 $ 1,069.05
1V1V:tt^X( At. PEM 101-000.421.000 S-i3o.3o
?;k.t�{;'J'Ett(:rit. Mrh 3{1}-{iftPJ-�t;?1,1d•A!{/ $�'{).33
PL1,1NISING F Mit 101 (11M419.000 S''1d.50
'14TR(l3nX11„�rt 'PEE iEEt�-% -�r
G"DaNG ; �E '1 01-0 0-423-M
TWftr3l;`kitTC.I'U1.tR FEH 225.000-443-34:2 'K000,00
Wf IN PUBLIC P:LAM - IZESM 701-(300455-(400 $468.36
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, 110N AND PLAN CT LE CK
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MAY 14 1999 LESS 13U -PAID SEES
50.010
TOTAL PE>Rtti1:iT FEES DUE NOW
$9,448.97
.�6 OF LAQUNTA
r
RECEIPT
DATE
BY l
DATE FINALED
INSPECTOR
4`
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...-A
TIC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2
Underground Ducts
Forms & Footings
2 _
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
— L
Exhaust Fans
O.K. to Wrap
Framing
Insulation
— /,Z _ �f�
l
F.A.U.
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 "
BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
G
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
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 r
Utility Notice (Perm) _
COMMENTS:
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