9808-200 (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
'72 z i24 B 7'/31/00
Dat' e .!/ �%" �� Signature of Contractor e
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.
( ) 1 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.
A AUKIC:AN INS. CLI. DWL%7w%UU
(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.
Date:�?- ^�Yw,Applicant
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
& 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.
a Signature (Owner/Agent) Date �/ /'r'- J
j BUILDING PERMIT PERMIT 9# CONTROL#
DATE VALUATION3I�5,22d,54 LOT 24 TRACT.�;A} C O
ADDRESSJOB SITE'
OWNER
CONTRACTOR/DESIGNER/ENGINEER
RIES:DENTUM, CONL"#`I 1 (7fION
5. PARK PLS ZJ/ STIL 400 �
5 PARK PLAZA, SUITE 400
IKVIN:E CA 1,1 2,614
IRVTNE CA 92614
�,
t7i4,c;�1�C00 CPL.# 5072
USE OF PERMIT
S.iNCi,E VAMILY DWELLING
S.FD - .2C-0.1, L OT4 24, PERA41 ' DOLS NOT :i'Nf:J IME tT.LOC K W AL1.
OR I'WI:,, PLAN C=HECK .V'RE REDLICEt] 75°ro'2� OR MUI,T GPIX ISSUANCE QF
SAME KAN TYPE.
CO3 TONT CONSTRUCTION 3,00.00 SF
PORCIUPATIO 312.00 SF
GARAOEICAR! OXO 695.00 SF,
ESMI 'SATED COVr OF COINS 7AUCTf.ON'
303.22-4-40
PEIRMTOUR. SU.AIMARY
C*NSTR.'Ut7'Z'IONrl~T 101-000-418-000 $f;360.30
PT:ANrXE-C9 ,FFK 10T 00{2' 39 ?11t $279.54
XC.c1AN ICAi. FEE 31224,00
�1.#s��'Ii s `AL I :r.� ' ; .101. DO S227.16
101-0OW4:19-000 5214.5i!
"T R0N( .k4QT10N ,►€,31D 191-000-241-(.100
'0111 .1DMIG:3 101-000-423MO $20.Ot1
3,Ni't2AS' VIC'T'Uitr C 225*00{f-t t3-342 16.000.00
RE,31D 701-000-255-000 $513.04
e-} r"
$J if3-,;f 'AL C ONST ►R.t1C ION AN D PL AW:1 i tWK
$8,769.37
LESS PR'PLUS
� f1.Ot7
NOV 12 1998 - OTAL PjKRTNffr a EEP.S DU NOW
S",768,17
2
RECEIPT
�.
DATE
BY .q '4
DATE FINALED
INSPECTOR
jo 74'. ?_
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
OX 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
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
COMMENTS: -
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
c�a
3 - sr*,qgY OF LA QUINTA
°sof GdUlt_ ING & SAFETY DEPARTMENT
r. v ✓ 777-7012
V 58WISPECTIO N 71Q3 EST LINE
Owner _ .FW.Q.HCILI,SIlYfs i •i -C
Confuddr IPATELLUS RESIDENTIAL
T GONST.
Permit Number 9808-1700
POST ON JOB INC NSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS . 79-608 LIG A
SFD - PLAN 2C -G1, LOT#24, PERMIT DOES
NOT INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL AB VE HAS B ENLSIRNED
CONCRETE SLAB -
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
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
c itis r Y v�
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNS
DRYWALL INTERIOR .4111,111
EXTERIOR LATH — Gj
POOL PRE PLASTER
F NCE & GATE _
SEWER EPTIC TANK
FINALS
ELECTRICAL 11-7
PLUMBING
FINAL GAS TEST
HEATING -A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING