9806-246 (SFD)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
,Date Y X Signature of Contractor s `l
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, 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 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
Section 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.
n
�i:�ir.S78_e00'1isQ .
(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 those provisions,tf.
ate:. 7 /4-2r :, Applicant -f">; , r
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 orpursuant 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. J '
i nature (Owner/A ent)—d`x f v ;'r % AZ/ .j Date
BUILDING PERMIT PERMIT# _ CONTROLJt.
S►TsL1C►-4f: ,-
DATE VALUATION $1 w�; 55 f� 44) LOT W y+- TRACT
{q ��0�3 6
-7 A'
ADDRESS izf JOB SITU 044 -CALL iR✓_S;,Rrtt :�iil1J
APN 6fs -to7 t-607
OWNER)
CONTRACTOR POESIGNER/ENGINEER
(/fel,till]�t�4ii`
(OL(f,#/'7.BAn14+3J''1L'sLyNTP,y44�j[1N:1i(3S.�1S�,C'�:y.�:�.
j��'t(I�IV{�D11,11,L(`,.t'tyMSASSOC:.,TNC.
i�`.•�'�SN AVE. OF (..i.1:. �\i� H8 `
! -900 iii— l.il,1rEHE w9�fl•.t,ES
PALM DESks12.!'• CA, 9221.!
PALM DESERT CA. 9221.1
(`rCf1� 5-2t2G y 'RLtl- 5203 '
USE OF PERMIT
013
:SJD - PA L LOT 4$. ALAN 39YL .CMAOT DOSS'IvOT INC'"LitM BLOC
Wr\!.L,4 OR P,0C1 ._.PLXNT CHj-.:CP:. F11',F PJA)UC'EO 7 8' FOR .MLILWPLE
I.SS!J,KW0,' OF St\ivE PLAN TYPE.
11ti,,LCT-`Oiv:C`iRUCTION' SF
POI2vk1/PATIO Sr
t3Af2,AOfAJ .A:I�Pi'1CGT 6_38.00 SF
T 1!LP.Ti COST € r,
pp•yy,,GG ,p + �; J ;y'p7'� (�.� gfi'.yaiTEtMA
S'e'J�'t<��%.G Y?�Ce.�3e. F-YN.d 1W�2�,��•�i4�1 {�.
C"O:f��; Cf�:Ctf.'-'tr';t��N 1�6� 10€.-(IEi[3••4!€�OSlO s7l6.tlta
s'I tltst 41 FFF 1Rl-i)(?t- 3v_3ig '.'�Ki.49
t�D�C'aJ:Fi�I.1.C;�U,1;.t; � 1#Jd,•�0-•�Z!-Qt?J - ��.Sa
•
.101.0 i0-420 004 $1SO.dt3
101405-4100W
i f,U.R if31NCl F,EF W
�:'iti�lL;�ti laiSl:. ��.� �ff[)O�i+123-���� .+f• •S'�'i►.t;ft
ttV! .LA,`� f fitff";i'IJft` I tsiS -d iJfi-vela. its 3,itkt!>lil.
10J.-000-44:1-345
u
IN � t3�1 f!1,F'fz� w',j 7411 pf?il,.255— oo
.tit"��1,
.i -w•.� ...--+. r -r.� -....rte
-.r. �. !.��i{•�-{Mrw.[.�.'-..�--•.•f�f('y
�.r--r..- ...'
•,;
�'p l�-y--•�.��
�_•� ; G,:]6 ?ty�Y l�.YLj'Y1J %w. 11tC:•'i. t 1+J 1!.i;1 l�t.:A,X C:1 -_1F
_. -�
�.J, .93
LESS i'ftl'-.1':tL� llfif);if?
AUL D 9V99� 'ra'If• a ,��tt.�a_� � l+a�t���� T�VCNOW
$4,06.84
SIT,( C)F Y:Q
RECEIPT
DATE .
BY. F N-7
DATE FINALED
INSPECTOR
I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
3
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs I i
Underground Ducts
Forms & Footings I
Ducts
Slab Grade 1:
Return Air
Steel !
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap i
F.A.U.
Framing
- -
Compressor
Insulation I
-ZS -
Vents
Fireplace P.L.
j
Grills
Fireplace T.O. i
Fans & Controls
Party Wall Insulation-
Condensate Lines
Party Wall Firewall is
Exterior Lath
Drywall - Int. Lath i i
Al _Z_
�i
I
X
Final
Final
LIZ
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs r I
Electric Bond
Footings
Main Drain
Bond Beam ;
Approval to Cover
Equipment Location
1!
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines !
Heater Final
Water Piping i i
Plumbing Final
Plumbing Top Out ?(
Equipment Enclosure
Shower Pans I
O.K. for Finish Plaster
Sewer Lateral (
Pool Cover
Sewer Conn ion ! {
O -
Encapsulation
,as
Appliances j
Final
COMMENTS:
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 j
Temp. Use of Power
1- I
t I
Final !
Utility Notice (Perm);
�s��