9806-234 (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
097117 B 10/31198
r
ae = r l Signature of Contractor 1 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
SeKon 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.
`;TA91? 11Jrd17fttt(1tt121i
(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
�C de, I shall forthwith comply with those provisions.
te: 1, , A L 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 el
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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
ure (Owner/Agent) Date 4signaty %
PERMIT# CONTROL#BUILDING PERMIT
4J11►b-z.1
DATE VALUATION �A�.hR,�! �17.�it1 LOT .�� , TRACT ,8)026
8t0 2 6
ADDRESS 44-795 (:AUE. 11LA006
APN 604-071-007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Csl IPHAITF AND WILMA VIS ASSOC,, INC.
01,11)HAt, ASS C'C'., 11ti'C
77-900 AVE'. OF 11- t? S 1'ATES
77-900 AVE. OF 'Ilih i Ctv ms
1'Ai.hl nf:51'sRT CA 92711
PALM I)17s51 ftT CA 922.i 1
f 7(101 i4S-?(i2ti Cf,?L11 570"
'
USE OF PERMIT
tit�t�
.>i 0 - efi 1, i.0T 36, vi,AN 3k;. I'fitii I I W118 NOT iN(J.Uuk; BIA,x
WALLS (* lh:x )1.. PLA14 (110'_X 1;1:1- RL1AX:0? 753* F'0_ It lM1LI1.11PLE
Is`;tfrlNCli 01; SANTH PLANT PE.
TRAV:J'07#149TRU010N 2,29100 Sr
PORC14/1,ku'to 1210.00.SF
t.FAKiat3llL'/LktPt>it 1' 638 (MI ;its
!p�'� 7Ii��I!. �i1'J \:K).r 9 ��(' 1�.':Jt l+7��•i\t �l, # Y\.�t1
1,�}����iY.'M II
i'1PR1*1H' Vi,K SUMMARY
OONt1'1'RPOTION VFE. (M -t>10418-1-0) 577ti►ua
P1 ;kw ('t 101 •(1f1f1 �t to: tit $ t 145 aG
1%011.!Mr'ALFlc i I()I�000A."1.OWG $641.0
H'sL 101.4iOi 420 -ow $150.0
PLII&IBIN0 irtai 1111-iiC141 r11 ft1A? S211 5f0
1 lol'fnN FIT -1 _ Rt"SlID 1014t(if1-1414104 1�1 t Hr,
c lt,li.tlldf.i 11:1: 101 400•:123-000
lhit•1Z,r�, rtt<lla."1 tO�i:1•i_t: 1x5�iil4}�4.5-a�I2 S�,ri81.� I
F'FFi i tti4i PLAN 101 •t)t1f? 441-_Z45 ffi 5.tt!)
NRT iN a►t110 u' Vt,,v1Fs, . it III "7h!-C1fSii �55•(l1111 $r•(j "t4
'A tR.`f C tI'111, C'(7t\14"11I11(,"17C tN AND PI�4N f 1;T {:"K
- - -� LF:'S PRIE-i'.AIi;1ITES
5000
01W, NOW
S4,4tw,83
JUL 09 1:.193
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
Ii
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs 1! q8
Underground Ducts
Forms & Footings 11
Ducts
Slab Grade 1}
Return Air
Steel { {
Combustion Air
Roof Deck I!
Exhaust Fans
O.K to Wrap 11
F.A.U.
Framing 1A
Compressor
Insulation II
Vents
Fireplace P.L. It
Grills
Fireplace T.O. if
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall I
Exterior Lath 1!
Drywall - Int. Lath ]I
iE
i}
I$
Final
Final Ip
POOLS - SPAS
BLOCKWALL APPROVA S
steel
Set Backs 1}
Electric Bond
Footings if
Main Drain
Bond Beam { {
Approval to Cover
I f
Equipment Location
I;
Underground Electric
liI
Underground Pibg. Test
Final }(
Gas Piping
PLUMBING APPROVALS
I:
Gas Test
Electric Final
Waste Lines I i
Heater Final
Water Piping I!
Plumbing Final
Plumbing Top Out I I
Equipment Enclosure
Shower Pans II
O.K. for Finish Plaster
Sewer Lateral it
Pool Cover
Sewer Connection II p —o2g —
Encapsulation
Gas Piping
Gas Test
Appliances II
II
Final
II
COMMENTS:
.
I 1
]!
Final ]1
Utility Notice (Gas)}I
ELECTRICAL APPROVALS
,l
Temp. Power Pole ] I
Underground Conduit
Rough Wiring 11
Low Voltage Wiring!
Fixtures 11
Main Service I
Sub Panels ];
Exterior Receptacles
G.F.I. II
Smoke Detectors if
Temp. Use of Power
� I l
c ],
Final it B/�• _
Utility Notice (Perm) �(,�