0002-188 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under pe n��'of pp'rJury that I am licensed pnder, provisions of
Ckapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my �icense is in full force and effect. I I
License # Lic. Ons Exp. Date
C174,074 2 r 0-7/3112V
Date, Signature of Contractor
I hereby affirm under . penalty of 'P'erjury that Cam 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
I am exempt urfder Section B&P.C. for this reason
Date' S ig, , nature 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 Jor ' by Section -37010 of the Labor Code, for the
performance of the work for'which this permit I is issued.
I have and will maintain workers' compensation insurance, as required by
Section.3700 of the Labor Code, for the Oerfo,rTance of the work for which this
permit is issued. My workers' compensation insurance carrier &'policy no. are:
(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 'he grk�rs' compensation provisiensof�Section 3700-ofthe Labor
Date: pplicant
Warning: Failure to secure Workers'(CO 'pensation coverage is un
shall subject an employer to criminal penalties and civil fines up to $100 000 in
addition to the cost of compensation, dama6es as provided for in Secti'�n 3�06
cxthe Labor Code, interest and moo . '
IMPORTANT Application
ishereby made
'mthe Director
`mBuilding and Safety
for o permit subject to the conditions and restrictions mm forth on his
application.
1.Each person upon whose behalf this application iomade & each person ax
whose request ond.ho,whose benefit work- io'porfo,modunder o,pursuant m
any permit issued 000result nfthis appnuaxunagrees to, & shall, indemnify
& hold harmless the City mLaQuinta. its officers, agents and employees.
2. Any permit issued obo result ofthis application becomes null and void if
work in not ovmmonvou within 180 doxe from, date of ioovonva o/ such
pennit, or cessation ofwork for 18Odays will subject permit mcancellation.
| certify that |have read this application and state that the above information io
correct. I agree to comply with all City, and State laws relating to the building
oonst,vctinn, and hereby authorizeqrepresentativesf this City uoenter upon
the above-mentioned 16 inspection
Signature (Owner/Age .o
`T/
BUILDING PERMIT
DATE VALUATION (1. 2 ft LOT 5 TRACT 25454
JOB SITE
ADDRESS '49-365RIOARNN'0410
APN 646_37
OWNER
CONTRACTOR DESIGNER ENGINEER
Lik QUINIA CA 92M
1,A QI(ANTA CA. 92253
(7601)77)-1941 WA, 299
USE 0 F PERMIT
Sikkoo SF
GIRAEANG 17=3 1.01-000423-000
AWf $171.40
RECEIPT
DATE
BY
DAT E FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
-
Underground Ducts
Forms & Footings
Ducts
Slab Grade
— Gil
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
-Cei
F.A.U.
Framing
Insulation
cam/
— _
Compressor
Vents
i
c
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
_
Condensate Lines.
Party Wall Firewall
Exterior Lath
— O
Drywall - Int. Lath
Final
Z(j �ci/
Final C6
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 Connection165
�'�
Encapsulation
Gas Piping
Gas Test
5
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: