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9705-026 (BLCK)Cn H N Cn W E; Z) co CW r CW � Z r- 0 Cfl WWT C° CL Cn Z Co LO N O N C) as `T"QO w 0 J J mUU O d � Z_ rb 5 rC) J 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 V Date fS /7 Signature of Contractor' OWNER -BUILDER DECLARATION. ff1 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 exempf under Section B&P.C. for this reason Date F- A r f 7 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 fo'r 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. MINIM INSIAZANCE (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 4th, those provisions. Date: �-/i/rP-7 APPlicak-1 1 0;r x �, nr 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 /Signature e above-mentioned property for,iris'pection purposes. 6 (Owner/Age-ht)•% t.< C: f', ^ Date's `� PERMIT # CONTROL # BUILDING PERMIT .� 5 0 8 3 DATE VVALUATION LOT TRACT SN7 JOB SITE APN ADDRESS 58-604 11NINFU14.1i) � ZfO'i+� OWNER CONTRACTOR/DESIGNER/ENGINEER ;rfP IE' : MON, L`t")NIF1"P11"( "1-10N (110. .iL+C;t1.t k;<1.ivFff,3.,1).AA 54936 SHOAL CREEK. LA. t.;if:JOrl'A C *A 92.253 LA 01JINPA. CA 922Y3 sf 1.9J7r1ati3 t r"t L9 3751 USE OF PERMIT f�fJfl..)�{if3i°a tii♦ 1",•1+.,'{' Li.l.sl`1liV1tY�.i 1h'!\fai., C'.11i' i:'s�`.ticyl�ilf"(1.1 442.100 .. Cc`�f`f5`CKtI�;'f1C"1�1;�#:t~ ' 1C�1-�i1()••�1q-(�i}U S.f5.041 G. t\ a "il,:I .Tt7rA�r, (-'0N11,;T—RLfCt10N-. AN0 PJAN C TRICK $15.00 LESS PP.F—PXtDFEES `js00) '*"0TA4, PFRMrf ttr'EF.`i C^ UE lVOW 5.0 RECEIPT DATE BY DATE FINALED INSPECTOR OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing Compressor Insulation .Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) .ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) o` s - WY OF LA QUINTA �.of S BUNG & SAFETY DEPARTMENT 777-7012 INWCTION REQUEST LINE o<C �'�� x777-7153 � C 1E40-%'NoTG0MERY Contractor Permit Number Vi" 9705-095 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 58-601 BANFIELD 64FT OF 6FT GARDEN WALL CITY STANDARD TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED IHUUUH LLL; I HIL; I RnI1f.H PI I lURINrl I t COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK FINALS ELECTR$:AL PLUMBING FINAL GAS TEST HEA-nN -TING A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO 7/96 TURN ON UTILITIES OR OCCUPY BUILDING 0.' �-ITY OF LA QUINTA (O nUILDING & SAFETY DEPARTMENT V 777-7012 QkSPECTION REQUEST LINE G\- y �� 0%Qom(, 777-7153 Owner �P C MONTGOMERY Contracto Permit N`uCmber 9705-026 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 58-601 BANFIELD DRIVE 28 L.F., 4' RETAINING WALL, CITY STANDARD TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED POOL PHL PLASILH I I Pnni FFNr`F A r;ATF �— FINALS ABOVE APPROVALS DO NOT INCLUDE RIGHT TO 7/96 TURN ON UTILITIES OR OCCUPY BUILDING