9612-124 (SFD)LlUF-N5t:U L;UNTMACTUR UEULAHATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7 . 000) of Division 3 of the Business and
U)
C\I UJ Professionals Code, and my License is in full force and effect.
CV) License # Lic. Class Exp. Date
LO
r . LU 714188 b 101-11W
r- CC
Z r. /Date 7 -signature of Contractor --
0 !`�-
P: (n OWNER -BUILDER DECLARATION
o
LLI LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 1, 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).
( ) 1, 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
U')
C\J Date Signature of Owner
0 C\I
0)
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the' following declarations:
C:)
U-)
0 1 have and will maintain a certificate of consent to self -insure for workers
X UJ compensation, as provided for by Section 3700 of the Labor Code, for the
0 -1 performance of the work for which this permit is issued.
Co -i <
< PQ I have and will maintain workers' compensation insurance, as requiredby
b 0 Sbction 3700 of the Labor Code, for the performance of the work for which this
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0) permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carrier Policy No. �f,
ob 5 MINIMILINS, CO.
0
< (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
s�pjbct to the workers' compensation provisions of Section 3700 of the Labor
Xode, I shall forthwith comply with those provisions.
VDate: Z' L Applicant
1b Warning: Failure to secur4 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 fo� 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 Zbove-m'entioned propertyfor inspection purposes.,
/Sionature (Owner/Anent) Date
PERMIT# CONTROL#
BUILDING PERMIT
IM12-124
-583
DATE 1/9/97 VALUATION . $1.12,010.40 LOT 37 TRACT '14� ,
JOB SITE
ADDRESS 44,335 CAMNO AZOL
APN
604-191-407
OWNER
CONTRACTOR / DESIGNER ENGINEER
FtANUJO OC(11111,0 L!"
cis.m-wv cRow-vt,i, comfuNmEs
15-4-S SOU111`1011 ST teor
.1 Sl%J1200 - - -
1 -5.15 SO. "V SURE M, S. PE'. 0200 -
SAN.1314,(NARDINO CA, 92409
SANBERNARDINO CA 92409
(909)381-6007 C131,4 2120
USE OF PERMIT
INr
I)T.AN CtIF K F1W 1101 -em -419-319
i 'k XCH iNNICAL, to., Q`
PLUN181 W11 FFES 1014M -419 -OW
S'17R.000 MC)TION (RFS) 101-000-24000 $13.20
GRADING 1011 -WO.42-�-000 =10,00
'225-W)"14X,X12 sm"970.23
A.Wf W PUIRLIC UILAC70, (REsq,) 'Iol-w)-258-ow
CONS' ' 1
PAit. I -RUCTION AND PLANCIT17r;1K
$4,802.64
.. 3
LESS PKTA-PiUDITZ.5
$0.00
AN
09 1997. 'OTALPERMIT FEW14,101JENOW
UWQ.64
CITY.OF LA QUINtA..
RECEIPT_ -TDAT�
BY
E FINALED --r!4SPECTOR
4 '
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
I DATETINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings 11111#4 -7
Ducts
Slab Grade Z7
Return Air
Steel fl 7
Combustion Air
Roof Deck 011YA I
ExhaustFans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation 71
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
E)derior Lath 7 A./-/
Drywall - Int. Lath
Final
Final �7
BLOCKWALL APPROV�LS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
I I
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lin es
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
ShowerPans /7
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
UU14 Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
E)derior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-Now