9712-118 (SFD)f—
CV U)
w
�O =) C)
d
o Z
�
0o
VJCD
Ha
U)
Z
co
L0
CV
ON
U °)
�a
z
�a0
X W �L
0JQ
m U U
O
CLMLO
�
't Z_
ob 5
r` O
Q
J
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
p %u(j! 2 �%^~� �� 7111
ate �7• / 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, 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
SeL ion 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 Policy No.
(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 S ce tion 3700 Zi the Labor
Code, I shall forthwith comply with those provisions
Y
jDate: / t 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
,any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatiives,`of this City to enter upon
thg above-mentioned property for inspection purposes.
ignature (Owner/Agent) / Date"/ <% +�
/S
-
BUILDING PERMIT PERMIT# CONTROL#
41)'f12-11)1
DATE VALUATION,«7.x11,• il� LOT7 TRACT
/
JOB 2"'1 -960 CARMELCARMELCIRCLE,
ADDRESS %
APN
trN+. F1��•ttli /
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'F.T?. !)i;S,:1;
11.0. BOX 1716
79295 K.ATtCHO 4A i.; JIN'[ A DR.
LA QUItsTI-A CA `F 12 ►
LA QUiN'1'A CA '022x3
{7i�Q17il-1+.>11 C111.11 45�'hi
USE OF PERMIT
L0T 7.'ALikCfO i''Lc1N 2 i - ART W PUI L[C Ct21:L'i i OF t
�'St>tt,tii k�Fiii AC.ii21':1•:A•tt;Ni' Vr'; t"1.+A641, I)F;V. F)lit'•1' ,'�,.. FY�•,
Gi ri
JAN
Z 5 1998
+�';i � •�++Li !�� iv:i iRifi.:; i :i.?ew •r.iE i•lii3 ,,^rig
Ir-_, !Nk9AT1'D 140.£+0 Si' r^
f C)
a e�.
LXq�.ie��49(A
(i/�l�frtlllfr't�!�1�(,.711'1' 666,(k$ :i
l• 1141 `'. l LOS" 0(' "ONS i R fMO i
C'1�iit\e'Lii
C0N:4'i'F21li,FI0N Flifi 101.01[0.4184W S1.437 '+rsj
l+t,AN "31IF(, K VVY 1f►l-{Nlt)..IZt+.i1St C1,1S!+^
I.:CIIA N1Ctt, I'll,1:?.•RUU-•1x j �`�0 St I;t.l!(i
1i1.1i�'I1t1C`e�1• t Iii: IUI•:itit7 ,iii-'J13(t 141114 _19
Nf.+lhihlN+3 t tiK It?i-!!lift d19 !kl!► 11 X1.2.5
tii'Ri1NCi Rti +'P1�?W i�t:1:: - f{f�silfl If1S •tKtt:41-=?.Zi•(N1f1Trt^ 7T
.
{. IZAL ii:fi :'i>i. 1f)i fll O 423•I)00
i14TFZA'.W 0k` f1ikR r1.1: 225 ?. +tiF int ck1
AWI' IN PUBLIC PLACES - ItE.`itli 701 -t}{_0 -255.000l 1
:x)2'1' i1V t�trstl,lr" 1�2_;Ar')?;t. Fti.3lr;';()t-1KNI,2iS..fN1ti .!I'�r� il1
�I.. 3-7 Yi1'►f, (,'0NS*TR1Is *PQN AND PLAN C'!-(t'Ci`.
LESS 1)RE•1'_ ID FEES
-$'SCk'? Ut
DUENOW
RECEIPT
DATE
BY ; ''
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
- �- f �f®9
Underground Ducts
Forms & Footings
_ /�►/B7
Ducts
Slab Grade I _�� i
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. LathE3_
I
Final
Final
I I
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 Lines
_2 _ �/ A
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
[o!Se:w-)(,r Con
���-t
Encapsulation
Piping
Gas Test
Appliances
Final
COMMENTS:
Final
'j� 0-01
Utility Notice (Gas)
d�
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
c
Final
Utility Notice (Perm)