0211-159 (PAT)LICENSED CONTRACTOR DECLARATION
I hereL*;r affirm under penalty of perjury that I am licensed under provisions of
Chanter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License #t�,g fpm iL�icY.YClass Exp. Date P�sv /2
Date �l ,off `? O `7 Signature of Contractor + ,P a �" pfr A 6,jwe
OWNER -BUILDER DECLARATION Jf
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 Sianature 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.
(s�) I have and will maintain workers' compensation insurance, as required by
Se tion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier STATE P1b(O Policy No. 0 464NE3-bi
(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 ,seo✓-a subject to the
workers' compensation laws of California, apd"agshould become
subject to tqe workers' compensation provisions o00 of the Labor
Code, Ish 1]tfo tiw'th comply with those rovision
Date: a p�1� 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.
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 rep
resentives of this City to enter upon
the above-mentioned property for ispecti
non urposes. ,
Signature (Owner/Agent) ^� Date�*�t�f`�
it+
�R =BUILDING PERMIT PERMIT1
DATE VALUATION LOT- TRACT
JOB SITE ADDRESS 49-1,45 �tA.���.HO Rt J3;}.�..1AN
APN 649-100-015
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PM L& Qi)WPA,, Ltd 'F
T1LOIS WE"'r]: HOU SING Ifs C,
9M INIB RT VzI 3. 04M 102
7 8,401 F1-1aGHWAY ) I `,i
SAN DIM 0 CA 92131
LA, QPT.W.CA CA 0253
('760)771-3367, C:BL6 4772.
USE OF PERMIT
Mrlo
20D ILK PATIO: CCfV?,3; &9JENSION, PER APPROVE''tat _ NIS
2 ORCI:fy'pxfIts 200.00 oil
=1Vd6^14A.A..Y' D ls3iJi- i,!.T Yrs yf®rriTurRi Bdaiq
.+S4 WIJ.\ifd
k11m°d`.�°i , INTIMN RY
PLAN C<HM9 i'`d:eE 301-000-439-3118 ?9.10
{`C1t9STRUCTION YZE 10,,.400-418-000 04.00
w
VP.UOO MOTION FU -1', +s 111 101-000-741 - x,50
RTT • .1 Yr. ,>kdT Ur1n 0R AND T'Uff CHECK,
$81.60
DEC 1 9 2002 z�T` POWMI m'.0c xfcOVIY
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DflEE, 3
BY l f%
D'AATTEE� FINALED
INSPECTO
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
o_
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
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)
COMMENTS:
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re
100-00 100.00' 110.00, 106.63' Q
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LOT 10
LOT 7 4CR PLAN
it DF 4DR PLAN a a DF PAD= 49.1 c
PAD= 47.3 F 4q.6
F 8 LOT 8
59 cl 21':
M
Iro
F
3A PLAN
PAD= 47.8
:75 sr
LOT 9
FF 48.3 DF 2BR PLAN
tK
7. 5' PAD= 48.3 F E=4 9. 1
DF=47.3 54.30TW
8.5' - 11
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47.07
F=49*1
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=48.3 47.37 7-88
47-88
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FS 100.00' 100.0 Ai 5.25'
1.00%s
1.00% Y.,,
JL I NAA LOT 1 1 •
3D PLAN •
vu Y�" - tA vcl, PAD= 49.0
— .62 47.04 -C FF 49.5 •
9
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C Ilp .96 TO (o
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