0004-209 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby affiral,under 1 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
1
699690 � 1�(i r2I1)53'' �� 12.1:31/2(
Date -1--11-4-6 `:9& Signature of Con�tr"actor�
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).
( ) 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
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 SPATE Fir14D Policy No. 3'93.40.0006494
(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'f I should become
subject to the workers' compensa`ioniprovisions of Section 3700 of the Labor
CodeJl stall f�hwitNcomply with h�o,se p v§ions. tr/
Dat bjj".kfI _}�Applicart��r��itf1
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 complywlth all City, and State laws relating to the building
I Y1
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned pro erty for inspection purposes.f
Signature (Owner/igen
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 209 TRACT
M320.00
JOB SITE
APN
ADDRESS 79_�Alq11 qj. o 0.
- r
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Md MAUMMR
911N"bm ScTtEEK & A iiIQ40. CO.
78«553 SAN M-A.PalO COURT
46080 CALUOUN M_ 1Wr
LAQUtNTA CA 92253
:ItMIO CA 92201
0160)347.0592 C BL# 4996
USE OF PERMIT
PATIO
PATIO CO'"P.- ALUMAWOOD PATIO COVEP, 400 SCS. j r. (tCBO 261I'P)
PORCHIPATIO 400,00 SF
c�
S' Al CGS': Ca -V comm-dCixon
51320.00
FERMff 1EE SUMURY
PLAN CHECK "—;' 101-000.439.318 $52,65
CONSTRUCTION PEE € 0 € 000-418-000 $81.001
STRONG MOTION FEE • RE91D 10€ -000-241.000 $153
SUB71WAL CO1TM1kUCTT0X AND PLAN CVUX-K
$134.1.8
1XW PRE-PAIDFREU
MOD
TOTAL P1~M'1 "KES DIM now
$134.18
kl
RECEIPT
DATE
DATE FINALED
INSPECTOR
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
OX 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 Firewa_i
Exterior Lath
Drywall - Int. Lath
Final
Final �/� �b _
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:
ld w Emu im - tri
NAME o1 / /1'L 001,56' 5-L,411Zi rZT e PHONE (
SITUS ADDRESS / 5�•3 ..�'�� �yja�.(��d0 G'
ASSESSORS PARCEL NO.
Provide North Arrow S _
REAR PROPERTY LINE
P� P C ro
10 P4-rs •o
CITY OF LA: QU.INTA
BUILDING & SAFET-Y'DtPT.
APPROVED
FOR CONSTRUCTION
A 04NSPECTION FEE of $30
WILL BE•CHAfdGMTTHE Al"M
PLANS AND 10B CARD ARE NOT ON..
THE -SITE FOB A. AAEODtED ._ .
INISPEC�1�' tOi� • ..
FRONT PROPERTY LINE
• Ste/ ��.��.�, p �T.
STREET ,�(76
AND SCREEN & AWNING CO.
46080 CALHOUN ST.
.INDIO, CA 92201
3470592 FAX 17601 779MV
,
t
l
( Q %Ti F
I 9-
14
aces �
SUNLAND SCREEN &-AWNING Co.
CALHOUN ST.
CA 92201
_(760) 347.0592 FAX (761
) 7®5 O F LA Q U I NTA
-- - _ ._ _ _ _ _ - -. - A--RE-INSPECTION-jEE.._OF...�30
BUILDING _& SAFETY DEPT WILL BE CHARGED IF THE APPROVED 1
APPROVED_' PLANS AND JOB CARD ARE NOT ON `S
THE --SITE- FOR -k SCHE-bi LEO------_
FOR CONSTRUCTION___- MSPEGAON.- - ; 71p56-3 S ,41) �il4le _ a
- --- .NO EXCEMONSI ,w ��i� Q u:L74 e,,4
DATE"_