0110-292 (PAT)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.. r
License # Lic. Class )Exp. Date
Date 2 ( Signature of Contraetgr���
J 9
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.
-K) 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:
Cartier kPAT :
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
.Set Backs
Underground Ducts
Forms & Footings
— a IV —,e,,2_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
=Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
e — 5
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 '�• q Z
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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:
Bin #
C
City of LQ Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-701
Building Permit Application and Tracking Sheet
Permit ;
0"-fQ
Project Address:
Owner's Name:
A. P. Number: 6 Q 3� — 017
Address:
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Legal Description: r2� 9�%
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Contractor:
City, ST, Zip:
Telephone:
a hone: ...............:............................:
Address: t7 l�_ 73/ MC(,:a y -n -
Project Description:
City. ST, Zip: �' ! �j�ieGA/
/
s¢ l vs �/¢7!fv Ja/ 17-
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P 3
................................................
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a U � S
State Lic. # : ?Sc_� 300
City Lic. #:
Arch., Engr., Designer:
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\
Address:
City, ST, Zip:
X50. �3 30
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Tele ne:
P
.......................................................
Construction
s ruct on Type: Occu anc •:
YP P
State Lis . #•
Project ct e (circle one): New Ad' n
Alter Repair Demo
Name of Contact Perso •' e—' a477Le?� ZC
Sq. Ft.: ) 4.57501t
I # Stories:
# Units:
Telephone # of Contact Person/C 3 %moi ' v'2 ��O
Estimated Value of Proje
APPLICANT: DO NOT WRITE BELOW THIS LINE
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Submittal
Req'd Rec'd
01 —, TRACKING PERMIT FEES
Plan Sets
2 2 ,�,
Plan Check submitted
Item
Amount
Structural Calcs.
y 2 Z
Reviewed, ready for corrections
� Plan Ch_ck Deposit
i mwl
7i l/
Called Contact Person
Plan Check Balance O
Title 24 Cales.
Plans picked upV
C nstruction O
Flood plain plan4
`
Plans resubmitted
�J Mechanical
Grading plan
2"a Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I. S
H.O.A. Approval
bp
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correctis/issue
veloptr Impact Fee
Planning Approval
Called Contact Person
(� - .I.P.p•
Pub. Wks. App r
Date of permit issue
School Fees
Total Pe mit Fees
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