9905-205 (ELEC)U)
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LICENSED CONTRACTOR DECLARAON
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
308086 CIO C20 10131/191
,/Date, Signature of Contractor id 44
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).
1,-as'owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
I Bm exempt under Section B&P.C. for this reason
Date —Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby aff irm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of 'consent to self -insure for workers'
co , mpensation, as provided - for by -Section 3700 of the Labor Code, for the
pe'rf6rmance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the v�ork for which this
perrhit is 1ssued. My workers' compensation insurance carrier & policy no. are:
Carrier' Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
certify that i.n.the performance of the work for which this permit is issued,
I shall not.otiiploy . any person in any manner so as to become subject to the
worke,,ts""Compensation laws of California, and agree that if I should become
sUbje c to the'workers' compensation provisions of Section 3700 of the Labor
do6e, I shall forthwith comply with those prov . . -..
�v�sions
�BW 7 � q 4 Applicant—
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.
ImPbRTANT 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 persoln It
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.
ture (Owner/Ageint`)`/��.-./����/�`—_4'—J�,1-./�l/ Date
PERMIT #
BUILDING PERMIT
"OS -205
DATE QN11 7/1 " VALUATION $1,400.00 LOT TRACT
JOB SITE
ADDRESS 4"47 COACH11,13,A DRIVE
APN
646-250-M7
OWNER
CONTRACTOR / DESIGNER ENG114EER
PAHUP 1) I)NO.MMUE
BERT 111HN-SON SPECIALIZE D 11,13TAIRS
49847 COACHELLA Olt
74043 OLD PROSVEC'POK
LA QTJIM'A. CA. 92253
111UM DESEWf CA, 92261
(760)346.6217 CAL# 1018
USE OF PERMIT
REMOVEAND I�XPLAOE- MLFM1 ICAL SBRVICU WIM brEW 125 AMP
,x
"IERVICE 100 U.NUEROROW4D 3UtV1(-R INTRANCE)
VALUATION 1,400.00 LS
1I.STIMATED COSIT OF MNS71911UTIvION
PERMIT -M."', AIMMARY
0XICTRICAL ITVB' 101 -000 -420 -WO IT33. SO
,Sft 1]R-M1'A T. Cf)JNS"nttJCT 'HECK
tN N�[.) P1,4 N C
$33
LESS YKE-PAUD FEES
PAKJ
$0.00
MAY 17 1990. TMALPERMIT PKES DUE NOW
3XITY O"r I A Fm I
OF L %AC'WJ t N-T;A,
-1-t
RECEIPT
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
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
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
ShowerPans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
-------- — ----- --
Final
Utility Notice (Gas)
E LECTRICAL 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)
-