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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
DateAignature of Contractor e'l
�j
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.
(r,)� 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.
9 TNXE iiW4D 229.40 UWa 0011 IM
(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.
D '
Date: -- nVApplicant
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 ingpection purpos S.
Signature (Owner/Agent) r 24Ao r' Date •-1 -•- A aJ
BUILDING PERMIT PERMIT#
DATE VALUATION LOTr TRACT
I Q1a'14f>d '. 3
JOB SITE
APN
ADDRESS
'.her -43::5 AVYNDi.R.RIMM AN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PIA ZO CON MITI CIVOIT C.0
PAZ WITSIMUMION CO
`52-995 W- W:t 07A
52-995 AVlA,;t1M4D0ZA!
:t.AQuilms. Ck 92 233
IA QMTr ±. CA 92253
USE OF PERMIT
COM krUITAWA040
PROPA'419 GAS 1"MI o ENCI-OS AF, 24 LF h W tiiJOi`.°]: WALL CITY
�T.R•kZ1��,N1�
4 FT, WALL 24.900 LF
CONSTRUCTIU14 FEF, 101-11"0-41S-000
OCT 16 2000
_
ter- LA Qu►N
c.
ISM .1 -IRE -PAID 111T.9
$0,00
RECEIPT
DATE
BY
DA E FI D
INSPECTOR
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
11 DATE
TINSPECTOR
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final ��/ �'
PLUMBING APP(((ROVALS
Underground Plbg. Test
Gas Piping
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
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
Final
Utility Notice (Perm)
COMMENTS:
9
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STHDXX
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FOOTING
3/4' DIM. HOLL' ,--
CLEAN DRY -FREE OF DEBRIS
FOOTING
3/4' MR HOLE L
CLEAN DRY -FREE OF DEBTS ..
X STUDS STITCH NAIL W/FOd06' 0/C
AM SIDE TO SIDE
4x POST WHETS OCCURS
TYPICAL HDU2
5 DIALL. x 9' ALL THREAD
SETQUM �/��M)
2X OR 3X PLATE
y EPDXY ONLY9 UPLIFT SITUATIONS
I • .. EPDXY REQUIRES OELSERVATION OF LIC
• : DEPUTY INSPECTOR
DETAIL
2X STUDS STITCH NAIL W/IOd06' 0/C
TAGMR SIDE TO SDE
5 DIAN. x 9' ALL THREAD
RW SET 8' (MIN) INTO EAST
FTG W/ -XP (TOC 2508) EPDXY
WASHERS 3' X 37 a229'
2X OR 3X PLATE
EXIST CONI
.. EPDXY ONLY(� UPLIFT STUAIM
EPDXY REQUIRES OBSERVATION OF UC
DEPUTY MWECTO R
41 FOUNDATION DETAIL
ZMRATIONOP TNEURAYZ; ANYDOP;;EORAWING5
6 AUTHORIZED FOR ANY REASON.
_/ THE DRAWING SHALL BE UNDERSTOOD TO BE REPRESENTATIVE OF
ONLY AFRELAMARY ANIOR SCHEMATIC DESIGN THAT CAN NOT BE
R81ED UPON FOR SO. ESTI ATE OR CONSTGICTON PORPNSFS
TL
UNSUOI TIME AS THE ARCHITECT HAS AFFDCED HIS WET SIGNED
SIGNATURE AND STAMP TO BUILDING AUTHORITY APPROVED AND
STAMPED COPIES OF THE DRAWING. THE ARCIT TIS NOT
RESPONSIBLE FOR PREMATURE OR UNAUIHORM USE OF THE
OPAWPI:uNn sUOIAPPRwuHAS BEET aerAHED AND THE
PROIECf HAS BEEN 891FD APEMRMO.
D Aq�y/
D . Gq9(
* " No. C11991
CAI 10/31/2011 Q
.A EXP. DATE
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