0202-228 (SFD)LI(:tNStU (:UN I HAL; I UH UtC:LAHA11UN
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
Date -� Signature of Contractor
OWNER -BUILDER DECLARATION
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, asp owner of -the property, am exclusively contracting with licensed
contractors to construd'the-1project (Sec. 7044, Business & Professionals
Code).
( ) 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
performance of the work'for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
SeEtion 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 Policy No.
!TATE FUND 991►-1t3�dCfi�-�1.
(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 thos vise ns.
Date: . Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above informationis
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
11
Signature (Owner/Agent) fi r!( -� w% Date 74 7"02
- BUILDING PERMIT PERMIT#
DATE/✓/ VALUATION LOT {,�,^q;`t TRACT g99q
�g �}
{� �y �f
U30.74_7.,
JOB SITE 4
ADDRESS
APN
4:!-41510 PvANMO LAA4 A OSAS
OWNER
CONTRACTOR /DESIGNER / EN INEER
TIM LA UW:CA, LIC.
Tk2AWS VIESi 130"3,MNO, INC
9-0&3 Jim, M, nm suni k 02
78-401 ti :NIl.01TWdt Y VI I
SAN M900 CA. 92193
L:AqL1m-rA CA 9225
'(760,Y17 1-3363 CMM 4972
USE OF PERMIT
131.1:Ir.P�i't..I°'DWIM ING
Sfn R I.O`f 0,: PUN 4Dk PERMIT DOES NOT CNCLI D& Bf..C+CK
WA,LA POOL, SPA, OR DIUVE WAY APF'iti7taCK 75% PLAN CHECK FEE
atI4 UC'k 1019 MR. MU1,TfP1,L 1SSUJWCF. OF S.&MV 1aLA.N TY rK
TUCT C'01 wY`1'RUC°TION 3,701.1791 aE
P+DRCH,/:PATY0 666.00 SIS'
0ARAC�l' CA1:t3t: RT 14$.09 ISF
E5"AUM114M C(Ws OF C'01NWRIUCT10fi
230,747„70
�`C+.:I2��` Iii �e'1�"b1/.iI•t,�.w'�'
CONSTRUCTION Tie- 101400-418;,000 %110.08.00
PLAN CHECK FEE 1G1 -00L1 �t34�-39� �2;{�.a5
WCHANIC i . FN 101.000.42 1.000
W.Y-CTi IUCAL FF?,E 101-000.420-000
PLUM8100 FAIIr 101.000,419-000 $191,01
S°fitiJNO MOTION YLVE 4 MID 101-000-241-000 $33.187
C3RAMNC,FU 101.000.4'23<000 520190:
•
?5EIEMPM3MPACT NFE $t,99Y3.On
AqT W PUBLIC' PLAC.'1"st3 .. k9sir x.270 -OW -445••000 576,0 .
7
01*3AM PLAN CHECK
�:�,�� ;t ;3.9s
C11YOFI-A0. ��� ,�s� I,rl. ND PKPII►,17A1D TI?, S
Sl; e. 7'O
CYTAL :E'IRA1UT TITUS 1) UX NOW
RECEIPT
DATE
By �✓"�
DATE I ALED
IN's P,EE,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
:2 J2L22
Slab Grade
EVIL C2 Z
Return Air
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K. to Wrap
— U Z
F.A.U.
Framing
- C9 _ L
Compressor
Insulation
_ _ C_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
- z
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 LinesI
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
��y
Appliances
Final
COMMENTS:
Final _
Utility Notice (Gas) 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)