9808-201 (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
)2.5424 B
f 7
Date � � 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
r
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.
(X) 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.
XTCfiV INS. CO. V4"t `9t37 �3u
(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, I shall forthwith comply with those provisions.
vDate: /f /3- /fir Applicant le—
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, `r1
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. .1
scorrect..) 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.
v'Signature (Owner/Agent) - Date
BUILDINGPERMIT PERMIT# °°NTR°`#
s
DATE VALUATION $2771022 80 LOT 23 TRACT A$JOB
SITE
ADDRESS l-310 i.isi9.
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MISHIWr HOUSING1;.A,
f;., TELL USI RESIDE i TTA1.COINS'TRUC'TIOX
5 PARK. PLA,A VE Q6 1
5 Pfldti ..PLAZA. SUrl'F' 4100
IRVINE CA 9.2614
1RNANL' CA 9.2614
1
(714)251,()100 CRL# 50711
USE OF PERMIT {
8 3JA „ 2A, LOU23� PERMIT DOES' I3OT.T7vi.;l;ibD£.'t LOCK WALL tirR
FOOL,
CTt Tom C *;T.r%.UCTlow 3,3X00 & .
€pi�RG1 P1 # 1 312.00 SF
GARA,r:3OCARPORT 695.00 ST'
- `fN
u : COST t
277,022,50"
.
E1-1iFE F,StfglVqpRS
C NS`i'It,LPMON :FEB 101 _000 -418 -ow � 2.5 41
�.�.>faiy ♦if�t.:6,71. FJ:Ti �(7�'VV1!"./+�. �'��S•9 �\!•v`7.fj.R
.
MECfi'fANICAL M 101.000,421.00 $92.00
LWTRICA1,,1±iX 101400,420-000 MAU
PLUMB.I G 1 101-(W'J-419-000 5186.51►
:'1'ttON6 'NO TION1 FIE - :WRM W-000-24.1.-000 $27.70
G,Ri l wo PEE 101-OW423-000 820A-0.
fi% R.A811`.R'iU(_- 'tJU FIE M-000441-342 $6.000.00
ART INPUBLIC 1:►itiACE'S -12 ,SW 701-000-255-000 $442.56
� els
StJ�?-`1�:�i'1��d C(J 'S OC':C1ON AND P1 AN CHT C K
5.9,262.17
_ LESS PRE, AID PE&
$0.00
J� y ✓. TOTAI, PERS, f FERS DUB; Now
$9,262.1-7
NOV 121998
RECEIPT
DATE= '•
BY
DATE FINALED
INSPECTOR
�.
-„
�f'
INSPECTION RECORD
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
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 I
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 E
Gas Test
Appliances
Final
COMMENTS:
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
c .
J
Final
Utility Notice (Perm)
r w •�
DATE INSP.
a
-
s s
-
CITY'Q�A.A QUINTA
Er O1
BUILDI'S'AFETY DEPARTMENT
GROUND PLUMBING
6rA ` 777-7012
PRE-GUNITE
INSPF �N REQUEST LINE
`��
DO NOT POUR CONCRETE UNTIL A ABOV HAS BEEN SIGNED
�, % 777-7153
JOISTS & GIRDERS
Ownern
ESERT
,. I
Contractor nPv,
�•n r rTS REcJltTi A i / 11NCT
Permit Number
9808-701
POST ON
JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-586 LICA
SFD - PLAN 2A, LOT#23, PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
-
FOOTING STEEL
V LI
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL A ABOV HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
e6 rl,G,
21, !i
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
Q
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT O 4' O 8'
FRAMING
INSULATION
-
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIQUED
DRYWALL INTERIOR
EXTERIOR LATH
S -
POOL PRE PLASTER
FENCE & GATE
(tEWOP SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST/6)
- l
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP ,OWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING