9907-313 (SFD)04
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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
63% 72 5 2 8 6M91,2N
Date / —6 - OD Signature of Contractor - 81
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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). I
( ) 1, as owner of the propegy, am exclusively Contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Cod&).
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
perforpance of the work for which this permit is issued.
(W)'o I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the w6rk for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
ROYAL rNS. CO, Or, i
(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 tho
Date: _L_ Z - 6.n Applicant—'
7--W -(7L- I
Warning: Failure to secure Workers' C /,pensation 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 sdbject 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. -
.. _�14% I . I . . . '
Signature (Ownier/Agent) Date
PERMIT #
BUILDING PERMIT
"07-333
FIX qALUATION S 1014, 2 4 2; .90 LOT. TRACT 1296011 -1
:wr%N 1 66 2000'
JOB SITE
ADDRESS 79-667 CASSIA-SI'RFET
APN
is -0-630-0i6
OWNER
CONTRACTOR / DESIGNER ENGINEER
5 P,��c PLAL�, surn., 400
IRVINE CA 9261.4
IKVfNL,' CA 97614
io7l,
USE OF PERMIT
KR)LE RAMIf V UVELIANO
SFD - LOT 4 PLAN JI ITAIWIT LA)ES 14(Yf R4CLUDIS _WAL1. OR
P001-75% FI.AN CHECK RRI)UL71.014 APPLOW FOR MULTI)ILF
TRACT CONSTRUCTION .1003.00 SF
IX)RCIPPA110 428A0 SV
441J10 SF
"ST11MAU!M MIP,'OF COM f RUM01V
1-
10S.1,1*4V*
MRAW FC)s' WAIMARY
FEE 10J -000 -419 -OW 9�7 1.00
I E, (".1 1,A, t, Jr I I
-00a.420-000 S120.43
PLUNROISIO VEE 10140"19-W0 S14100
.-,TW0W0?Vf0Tll0N PRIK Rf!�Nfl) I n 1 -IM-7421 �W) 'po,sm
1_';R AV4 "40 r. LC
Af,,rr fN PUBLIC, vi,ACES
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L LOVIEM JIMPACT F 5
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1�3.00?R 37
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T0J'A L P C H NITY F C R,10 1) U F, N 04V
S3,093.87
RECEIPT
DATE.
BY--�'
DATE FINALED
INSPECT . OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE —TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings -C1
Underground Ducts
Ducts A.
Slab Grade L/-
Return Air 49'
Steel
CombustionAir
Roof Deck
Exhaust Fans
OX to Wrap
46V
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 12- - -zc>
Final
Final
BLOCKWALL APPROVALS
POOLS SPAS
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
Water Piping
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
ShowerPans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas) 0.1-1
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)
COMMENTS: