9908-005 (RER)LICENSED CONTRACTOR DECLARATION
' I he.!,eby affirm under penalty of perjury that I am licensed under provisions of
C apter 9 (commencing with Section 7000) of Division 3 of the Business and
Profes,ionals 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:
( ) 1, 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)_ '
O ' am exempt under Section B&P.C. for this reasonVd
f
ate I % `/ Y Signature of Owner l ?,:/I r, r .141:! 1s i.r .
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following 'decl arations:
(.) 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.
(This section need not be completed if the permit valuation is for $100.00 or less).
(,K) 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. `
abate: t `ri` > 1r, Applicant > r (/ % ! [. 7 ; a 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 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. 1
/Signature (Owner/Agent) > ;J i
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
POOLS - SPAS
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 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:
PGA` WEST:RESIDENTIAL>ASSOCI.ITION INC
No'ticc of.Architectural Approval
This shall serve as written notification to the Ctity of La Quints tlk Kevan andAmita DeI,Grande of
55 850 Pinehurst have gained written approi;al Iram the P,GA��Uest Re ide�ltl Association, Lric.
Archit ' ural Committee.and R irum'a'�Managemeni Erttployee of the Horneowner.A'ssociation.
,- s u 'c . .
Specifically, Mr aril Mrs:'Del Grande have the approval to proceed vwith`the installation of a sliding `
glass door on the dirung.'rootn.w,all uf`their unit This signed app'rwl irnusi precede the. issuance of
permits from the City of La Quints.
Architectural Commitf a Date
F
H i - ate
FROM K AND A DEL GRANDE PHONE NO. 406'395 4856. Aug. 04 1999 11: EDAM F1
CITY .OF LA QUINTA SUB-CONTR C LIST' //
I
' JOB ADDRESS S5'-�sa
PERMIT NUMBER OWNERBUILDER_40[/V�.>
form bg the
the Building Inspection Card at all times in a conspicuous glace. Only persons appearing on this listor are aufhorized to work
This shall posted on job with
on this job: Any changes to this list must be approJed by the Building Division prior. to commencement -of work. Failure to comply will result in a stoppage of
work and/or-the voidance
'of buildin ermit: Foi each a
licable trade, all informal on re uested, below must be'com leted b,y applicant. "On File° is not.an,acce table res onse.
Trade`/:Cle'ssifieatlon ..
Conirector Stete':;CoirtractoraLicense :. Workers.Com ensation Insure"rice
Cit .Buslpess e
Company Name ' Classification License Number 'Exp. Date ninevName Policy Number A Exp Date
license Number
Exp. Date,
,, 1 (e.g. A. BC-8) (xxxxxx) _.- Ixxlxii/xx) le.g. Stele, Fund, CalComp) IFormat Varies) (xxlxx/xx)
fxxxx)
(xxlxx/xx) .
rnow'
.,.
CONCRETE IC 81:.;
- - •
STRUCT STEEL IC 611. . °
'
-cy
MASONRY.:IC 291;
.
PLUMBING IC
HVAC i 201
..
:E gpl!CAL IC 1;01
ROOFING !C ;391 ,'
SHEET METAt IC 431
FLOORING {C 161
-
t3LAZING (C 77)CLk
S D ii �I' ` S Jk/`'' I goo
•-
INSULATION IC'21
•
SEWAGE DISP (C-42)
�,,
PAINTING IC 331:
r
cnelNETs lc BI
.