0403-025 (SFD)U)
F-
N_ t)
W
O =) M
r� p u7
LLI
s:pZ�
.(0
r—
F—
LUa�
U)
Z
M
I0
—N
OQCJ
U
D_ —
Z
�
QCr
O
XWY=
mQU
�U
d: L.0H
't Z_
Ob 5
C)
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
763 V37 :B V3,1 i0s
Date 17- nt2rSignature of Contractor
C'
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.0 . for this reason
Date ISignature 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 STATE FUND . Policy No. 1612263-£12
(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. /.f ,
.Date: / �x/ Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is. not commenced within 180 days from date of issuance of such
permit, or. cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City -to enter upon
the above-mentioned property for inspection purposes.
.. �I�Signature (Owner/Agent) 4—C Date T.' 7 -tel ,
BUILDING PERMIT PERMIT#
1325 V
DATE 17 VALUATION LOT TRACT
44
y
JOB SITE t
ADDRESS 18LL''. n
APN
775'..MO-0.1 T
OWNER
CONTRACTOR/DESIGNER/EN (NEER
CMV L-A,Qm14TA -n) u)
NAi'O[cKUVE RESORT COMULDIffaS"�. S, RIC,
200 R *WA!,KMqQT0N AVE, 6100
200 3E, T AM -UNG OOT ME, 111 X 0
COA+XSmo 0%. 92025
SGOk�f TDO C`°.'A. 02-025
(760)8;39 ,8228 OBLO 3413
USE OF PERMIT
pm w pp p qy y
li r r��p �y r y�yA F 9 p
`` yy� � py /a aA y� At�� y ` 1, q,.�J.q y�/q ` NOT
330 V L,O .44 .PI.A i I L T'E).'LfVi T iJLlMS NOT JI�IG L,'UV SLAX;K 1VJ-�I. LS' ,
P001., ,S PA 0171, D-iatWEIMAY AP110.0ACH
CUSTOM CONS` RUCTI iN Z985,00 aF
POPtC'HPATIO 15$.00
gSFJf,?.h�'i►,:l�:,i'�l CAkC1�L' RT 611100 1�.Y' i
COrISTRUCTIONIFr.E 101"000.418.000 $9,10.015
PLAN CHECK' YEE 101-000-439-318 $964.05
MECHANICAL SEE 101-000-421.000 $10.50
L?LWfRICAi YEF '101-000.420-000 $192.96
P1•JfP,AOR40 ATF 101-000-419.000 $10A125
S T IU YINIG MOTION FEE - R:SID 101-000-241-000 525.05
C11iADR40 FEE 101-000-4.23.000 $15.00
.D !'VM,E.3P; T ''. 9A1 AXT FEB $2,405A*
ART IN PtJ1'sLIC .PL.tNO - RES1I 270-000-445-000 sx26.16
Stm-TOTAL CO;N'MU't'"1%,oll Alll im PLAN CfFICX
$5,218.917
L=S3 d YZ-..PA1D PrIM
$0E 00
n
MAR 181004
CITY OF LA Q�UINTA
FINANCE D
RECEIPT
DATE
�Y/ter
DATE FINALS D�
INSPECT?
INSPECTION RECORD
OPERATION-
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs /Underground
Forms & Footings d
Ducts
Ducts
Slab Grade-SX2 /� �p�
Retum Air
Steel I
Roof Deck
Combustion Air
Exhaust Fans
_ - _�/
O.K. to Wrap Z,v
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 7
Drywall - Int. Lath 61
Final
Final
BLOCKWAL 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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines_
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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 117 A
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
tiA 12"'Q__..
r�