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
11
i0131i98
at" e Signature of Contractor
✓ y. _,�
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:
Carver C� Policy No. 4'
N
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(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.
/ate: ir,, b- ,.;....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 W06.
of the Labor Code, interest and attorney's fees.
Z, ;
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 atr;,
"
—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 vold�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.
/ `
I nature (Owner/A ent) ?�i - �' I i a. .r 'Date
PERMIT 1 'CONTROL
BUILDING PERMIT —'
��806-234
A
_a
DATE VALUATION$13LOT 1 I�TRACT
JOB SITU
ADDRESS 4d -72 e5 £` 3: a' , CM
604-071-007 �
OWNER "'s
CONTRACTOR / DESIGNER / ENGINEER
OLIPHANT AND W1t,IJA.MS ASSOC., INC.
01APFILAINT c%:NP? NVII .L:lA&;S ASSOC,, 11141C.
77.S100 AVL. 0FTHE S
77 -WO AVE CJF'i HE ;5'i'KIS
PALM 6HS'ER,J,' CA 92211.
PE1LIM DES1~U CA 9211i '
(7760)145�2526 031:,4 5203
USE OF PERMIT
SF_,:► - FH J. LOT 3-1, FLKN 31v PEiltMT f cza Nov INcL X75; iabci
WALLS Of21*100,,11- PLAN Ci-i.FC k 4',WL 1�0;'iOfJt; EO 7jvf0 ,'r'OR MU11.'.1')1U.1.li
[.SSUl`WH01J iAMEPI.tW'f'YPr_
TRctkC,T L.OL NSTIctIR:'r10 4" 2,292,0(7 ,34
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00itCH11AT1.0 120.00 file
0AICA.00CAl:Vt;IWl' 638.00 S
. 6L1:i•3. �! Li!/.'i!/`i �%.F Y•V•'�,/l} ii.,'1.M1��:V�f•A49J -YION
+a�!:al� '.i'dtE�t"f`iftN FEE 101-((ft}AIY,000 577&0.)
K fi N r'1•W.C1 : i111Yi : 49
tt,'�.�i1;.r�a,Siuls 1()I -0^€1 D-(!1® W.fit)
;�:.:t?.C'tftil;.ft+i�i�1�J< � ;a►t-t't�-X70-f)JCt �;1:'�U.<€ri
k'1..7!NI:f3tN{:f l�f f?,: 11)1-f10()-�il� CsiD11 521 L50
�Trn.►wi•ktt)'t`ir vr-,f r;''ff;' 10i4?On-241-0000
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is+lt.eSl err"".�O I°13£s"" t�.t.•UCQ-��t.�..(9.C30 u r�l.tlQ
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PRO".A.1311F. PLAN itff fldo.441-145 S25.uf)
7orow)-."'55-ma tAfi,34
' s ;f alt !`t; '„ f { t "NS1TrZjC'"I'1C31 E1F311 �'i;_<1N f'1 1 f.:s
$4,600 -KI
#'Cb'8AL }'.6+;# t�.1T �'i?:#'s.�f )t?.#+:NOW
$4,606.83
- y
JUL 693
bREC .!PT' -
DATE
BY !
DATE FINALED
INSPECTOR
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
J
Exhaust Fans
O. K. to Wrap
F.A.U..
Framing
y/ Y
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 APPROVA S
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test -
Electric Final
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
p — -
Encapsulation
Gas Piping
Gas Test
1
A pliances
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 2 /
Utility Notice (Perm)
COMMENTS: