9804-171 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H " Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 co Professionals Code, and my License is in full force and effect.
O =) M License # . Lic. Class Exp. Date
'-- CwiLO
a2x1 F3 i2f%I/9�+
r` IY
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Z ate 1 tf ' 1 Signature of Contracto ri r ? s 1
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r- I.- C:) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ d License Law for the following reason:
Z( ) 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
ON Date Signature of • Owner
rn
U QWORKER'S COMPENSATION DECLARATION
XI hereby affirm under penalty of. perjury one of the following. declarations:
FZO () 1 have and will maintain a certificate of consent to self-insue for workers'
K W �= compensation, as provided for`:by" Section 3700 of the Labor Code, for the
J J Q performance of the work for which this permit is issued.
n Q U ( I have and will maintain workers' compensation insurance, as required by
j C) Q Section 3700 of the Labor Code, for the performance of the work for which this
i LO Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
J (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"
3 subyyeect to the workers' compensation provisions of Section 3700 of the Labor
Cdde, I sh II fo hwfth comply wi those provisions! y
abate: y Applicant 7-f �-+•�-
Warning: Fa lure to secure Workers' Compensation co rage 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. ;k
1. Each person upon whose behalf this application is made &each person�at
whose request and for whose benefit work is performed under or pursuanV o
any permit issued as a result of this applicaton agrees to, & shall, indemriif°y
& 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 propertyor inspection purposes.
ignature (Owner/Agent) r ` 4,177 7 Date
�2
BUILDING PERMIT PERM' s> /CONTROL//
��E�.•�
DATE VALUATION LOT LOT ��� TRACTJOB
'41
SITE!
ADDRESS ` 9-634 COMM COURT
APN 60'SOi8 -013
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.110 1`1XC IL'�012 G.tC3Lrtt'
1('
��1;EC;l:;4: `i4a4:.1..4 .:':li;?1ZCrt?t.:S;� ASSOC.
7s-615NAPLES ilk.
78615 NAPLES I:ik2iV1
LA. QUI NTA. CA 9?2:S3
LA i+►I.T14V`rA. CA 92253
1858
USE OF PERMIT
SF I
9117 L..O't' 3G, .PL.AN SA. a M),11 T GOES NOINCrLEJDi zit IX WALUS O.€t '
BOOL.: E7LAN' (:k1F C9. M3 R.E()Lf4[__FD BY 75%FOtd MUL:7'LP1:.Ea' ISSUANCE
OF SAN% PLAN TYPE.
TRA -C.1' COINSIMM7F0ti 00, GO SA,
4�i;3i4.Ffi,C'AI'IC3 • i€ifi.C+tl X31
Cft\f A 6j"CAR1aOXV 11=19.010 SE'
:MST1?t1 n,1D CONT 013' CCNS'A .UCTWIN
141,24,13.40
.
P�,,*RAfiT VC .6.BVrt{JAK
-
CONSTR.t•IM..10N F EVt it33 ESQ 4.i -t)i)t) 57 3.50
PLAN CLKFRE 104 (1t}(1-,��o-�11t `6E67,9i1
�'ii:� 1;iP�iti��C•`ril;. !`a:F's ii?.1,-G1k1-�21dE� ��EsUfl
t�.Lt:=t;Tts.CAl.,E1's'P; lfia.`•i}i)(}-a42(�-QC>0 �l�1.4i1
PLUMBING FEM. FEM.101-W)4119000 $140.73
,VrlC* VO?UDN FFE - liv711.) $1(4,12
{Qy�1r-iw.7A.j_fQ10
GRADING LL10
1NkkA:i'1`.etlj::l'UREFEE" 225-000-443-.342 $it,:ttQ.2T
Al2"1 LN 1ya3t31.:i�;1'L.A1�1S-1':L?Sii.: 7031.-�1�f'-Z55-i94)il $1U$.12
r' `[!]3= f0'ft14.r C;'C3N`s1.L?� i'iC)N AN�"E I'J.t�.N"1I1CK�,?5.4{•►
LESS -M -PAUD FEES
WOO
a A .1 AJ
4Y 04 1000 ... .' .
"GE1P �/�t,
•
BY f
'DATE FINALED
INSPECTOR
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
Insulation21L
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 z
BLOCKWALL AP ROVALS
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
Q
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
_ Q '_
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
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
t
Final
t9tility Notice (Perm) -I?
COMMENTS: