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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 '
'114,
10/31, (
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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
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one, -f' the following declarations:
O 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
ection 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.
0011DEN E a G1.81:4v ' N • 49iNi� t12
(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
su/bject to the workers' compensation provisions of Section 3700 of the Labor
e, I shall forthwith complyewith.thoQse provisions..
%1/bate- J,I� ' Applicant 17J
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 186 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 Jaws relating to the -building
const uction, and hereby authorize representatives of this City -to enter upon
the bove-mentioned property for inspection purposes.
kSlgnature (Owner%Agent) P. r � � -- � bate L,
BUILDING PERMIT PERMIT#
DATEt yry4wLUATION LOT.TRACT
JOB SITE
APN
ADDRESS
79910 DAY A
7 -490-0*1
OWNER
CONTRACTOR/DESIGNER/ENGINEER
iTUR1C
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SP14 BEIRIS1i1k 70 QA . 92408
SAN BMtiAKMAD CA 92408
-6007
.(909)381 cz
USE OF PERMIT
1,10T I1,PLAt+t 3A, SP'C3 = PERMIT 00PS 110T riNcLuot uCF&'.:r'St7I3.us,
MULL.:£YP11R ISSUANCE OF AMA P A14 7"yPZ
elun7`0M 016TRUCTIOW 2,31s.00 SF
VOAC1,TVP.t? T19 ':57,00 Sp
0AeRAMICARPaRT (SP) !k576,40
ESTWATM.T. COST OF C01491RUCTION
23113153.00
CONSTRUCTION fSt 101*000.418"000 .. $1,10,1113
PLAN CHECK PUZ 1101�000439_318 $222-47
1 CHAIIRICALPE9 101-000.421-000
k01••000-420-000 $lei .23
P''L.UX49'MC1 FRET I G1 0W -415.000 flog;io
mT1ti.ONO Mt:;''1'ION V'/_ t RESID 101-000-241-000 $2114
ORAD1140 FEE 101-000-423-000 $20.00
DVVE OPNM.lMP,9.CT "-Z
ART.. M PUBLIC PIAC-63 - RM— 701-000-253;OW $'9'3,38
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Sk IB-TOTAT,CC.yMI'YIZU'C�'`�tOM�ANDPL.AX alVXX.
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DEC 1 2 0 IMAI, VER&ST d' IMS DVE NOW
RECEIPT
.
DATE
BYD
1
FI A
INSPECTOR
-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
_
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
r
POOLS SPAS
BLOCK WR LLLAPPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste lines �f
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final �'✓ —
_ _, _
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
_
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
_
Smoke Detectors 77
Temp. Use of Power
Final
_
Utility Notice (Perm)
0.
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Certincate of Insulation
--- -------YouLHomahas.bscn immolated v►nth Cacisin' Fika 1t�Wat�on �+odua which we de lied ------- for totisys safaty standards sad tomorrow's enerV regoiremenls.
lribcrglass 13 inc►sgtmk and Ss WhM perfidy nencoabetstiVe, so it does not hwe to be treated
wA' that can caavde whim& or MUL Magbm wilt ad abuab mai We nor will it
This abo certifies that CertainTeed Pam Grass k auktion bm.been, p efeasioaalty i d in this home.:
to provrda 46 folowing t$ermai pedemaasce-
~-- — — - — dnb Nam Buries Tnmb 028719 Pian ft 3A Phssw 2
Ceiling Arca; R-38 Blown inauiatiaa Garage 6hinw Non Aecem -
V11t Uviag Above Arun
Eaterier Walk R-13 Unfiood Haas
Werlor Wags: R-1 I Unfaced Baits Between Floor:
SM€iWRIO Q &A. OJINSU SOR CO., IAW-
Alecto, Tentm V2s"
sip
Toga Berry, General A9rg,Te6 Temwala Wanek -
R- means resistance to heat flow. "IUM higher the R- vahte, the greater the Insulating power.
Ask your builder for the fact anent on R- value& Keep this certificate with your other
vdacd papers. if you eves sad this home, this certificate shoald ba passed os to the buyer.
a,.
05124-/01 TH1 13:19 FAY 760 7727193 JOIN, TANG
REGNMEO WSPEC OR'R WEEKLY REPORT
zoiu
JON TAHOY
97690 Madel AVG.
P99M DeseM CA 92211
® (760) 772-7992
FAX (760) 772-7193
Pager (760) 77
TYFa ®P
INSPECTION
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CERTIFICATION OF COMPLIANCE
1 HEREBY CERTIFY 'THAT I HAVE IN! D 10u � STS OF
KNOWLED69AUQFTHEABOWRE WQRR
NOTED I HAVE fOUNO THM WORK TO COMPLY VAT" THE APPROVED
PIANS. SPKW4CATIUM AND APKJCAG f SECTIONS OF THE
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