9611-058 (AR)U)
C\1 LL1
C:> Z) c?)
() u)
LU
r_ CE
z
0
j:: cy)
c) —
LU w (0
a -
U)
z
C0
1.0
CNJ
0 C\J
Q
5
'IT CL
C> Z
Lr) Cr
0
X W �=
0 _J _J
M _J
id
13�
0)
19t z
cb 5
0
_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,o :;lass Exp/cDate
0 711 i M
Contrac or
Date Signature of
OWNER -BUILDER DE16LARATION
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).
( ) 1, 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
S2�ibn 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.
STA'IE 17UNIIJ 0710M -f
(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 permh is issue
I shall not employ any person in any manner so as to become subject tothe
workers' compensation laws of Califorinia, land qgree thatif I should become
subject to the workers' compensation, provisionslof Secti(n -3700 of the Labor
Cdbe I sha I forthwith comply with those �r6visions.-
/6ate:' I Applicant—
warning: f allure 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 wi subject permit to cancellation.
I certify that I have read this application and stAte that the above information is
correct. I agree to comply wift�ll City, and State laws relating to the building
construction, and hereby authbrize representatives of tl4is City to enter Upon
the above-mentioned propert;f6r ins�ection i!Iur , se
PO S/ Date f
Oignature (Owner/Agent)
PERMIT# CONTROL#
BUILDING PERMIT
961111.0.0 5 8
,4
DATE JV10196 VALUATION %1.5,219.jjt� LOT 10 TRACT 2,41
JOB SITE
ADDRESS 786-9% CARMEL CiRCLE
APN
649-210.035
OWNER
CONTRACTOR / DESIGNER ENGINEER
T.D. DRSHU* DINPLOPNIP NT
SPAR Ks cotigntIMMON
VC), 13OX 1716
79295 RANTC140 LA OUINI-A. DR.
[,A QUIM-A CA 9 225 -1
LA Q�JINI`A. CA 92'19
(60)771-1941 CB119 2996
USE OF PERMIT
ADD 1180 S.F.TO GMAT ROOM (S) 1.6-n.00 VALLTATION) AND' 2170
3F. (.)F C0V0(FA) PORCH IS3,59 1,00 VALUATION).
IdNOI)EL - CITS"1170NI I S.F.
ZT00) sr.
riNrINIMIED CXXST01C CONSTRI)CTION
15.2119.00
If EX N1 I T FE E, St i M N1 A k V
PLAN CNECK I-TH 101 -W)4,14-118 3111115
STRIK310N Fl[li: 101-W-41IR-M) S17I.C41
CON!
101-000-1.121-000 $15.4v
22.5AM-44-1-342 $26 1, 63
quivricyrAl. CON5 M-1](MION ANDPLAN,C]ITUCK.
CITY
$581 -tit)
OF "
.LA QUINT'A LESS PRII-PAII)FEES
so.rg)
TOTAL PERMIT VERS WE NOW
DEC 19 1996
$581.60
FINANCE DEPT
RECEIPT
DATE
BY'
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
i DATE —TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Root Deck
ExhaustFans
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 3'(9--91 7
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 Pote
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
E)derior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Wity Notice (Perm)
'COMMENTS: