0305-346 (PLBG)a.
I certify that I have read this application and
' correct. I agree to comply with all City, and
construction, and hereby authorizel`represe
the'above-mentioned property for inspection
�//r' i t -• i
�Signat'unL(Owner/Ag nt)'r
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
c75. �j c 30/0'5
� 1
atel,,'- Tom` ' Signature of Contractor'
i
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.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurancecarrier & olicy no. are:
Carrier NATIONAL UNION Z Policy No. J 1530?
(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.
Dafe:`n t ✓ f I% Applicant -,.-
sr
Warning Failu e!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.
state that the above information is
State laws relating to the building
ntatives of this City to enter upon
purposes. 1
r.- t '
2�'3�i
Date_
- BUILDING PERMIT PERMIT#
DATE VALUATION LOT !Cli TRACT
JOB SITE 4n.�; 7.! �i�t'i��.y�!!a?�.li��.
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
GY '•i•V� .Pi��'4'1S f.�•�u. tti.,
� l "l•VV F'1�.3.::rl a.lil SIG•
CIA 929331
.I.A wLNITL A CIA 928813r
OM, 687 f:
USE OF PERMIT
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00100
PLUMPIP. O PER 103 0)0-429-W
f
IX- PRE-1 1AIM IT
'!; OI L 3' ? N11 T V~_71111� AUS' NOW
As -00
RECEIPT
DATE
BY
DATE F ALD
INSPEC R
f� 1-
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
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)
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____________________II
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OPTIONAL GATE & FENCE
Oreas
Plan 5 515 • Elevation A
2,121 sq. ft.
Shea Homes for Active Adults reserves the right to discontinue or change specifications or designs at an time and any prospective buyer is aware that any
promotional materials that have been viewed may have extra features or improvements. shown therein which may not be included unless specifically provided for
in the purchase contract. Prices, features and amenities are subject to change without notice. Measurements may vary slightly without incurring any obligation.
Floor plans will vary depending on exterior design. Check with your Sales Counselor. Illustrations and renderings are artist's conceptions and are not in
to
show specific detailing. Model homes have been professionally decorated for your convenience in viewing how furniture and accessories may be arranged. Among
the decorator items are certain light fixtures, ceiling fans, floor coverings, w pa er, custom paint colors, window treatments, furniture, built-in cabinetry, mirrors,
pictures and accessories which are not included in the price of the home. Landscaping and certain outdoor additions are also excluded. Please ask your Sales
Counselor for details about these items -and the options that are available to you. Pursuant to Fair Housing amendment Act of 1988, housing at Trilogy at La Quinta
is intended for occunancv by at least one person 55 years of aee or older Der unit.
OPTIONAL I - I
LAUNDRY I I 1 I
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BATH
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____________________II
1
I
OPTIONAL GATE & FENCE
Oreas
Plan 5 515 • Elevation A
2,121 sq. ft.
Shea Homes for Active Adults reserves the right to discontinue or change specifications or designs at an time and any prospective buyer is aware that any
promotional materials that have been viewed may have extra features or improvements. shown therein which may not be included unless specifically provided for
in the purchase contract. Prices, features and amenities are subject to change without notice. Measurements may vary slightly without incurring any obligation.
Floor plans will vary depending on exterior design. Check with your Sales Counselor. Illustrations and renderings are artist's conceptions and are not in
to
show specific detailing. Model homes have been professionally decorated for your convenience in viewing how furniture and accessories may be arranged. Among
the decorator items are certain light fixtures, ceiling fans, floor coverings, w pa er, custom paint colors, window treatments, furniture, built-in cabinetry, mirrors,
pictures and accessories which are not included in the price of the home. Landscaping and certain outdoor additions are also excluded. Please ask your Sales
Counselor for details about these items -and the options that are available to you. Pursuant to Fair Housing amendment Act of 1988, housing at Trilogy at La Quinta
is intended for occunancv by at least one person 55 years of aee or older Der unit.