0003-203 (SFD)LICENSED CONTRACTOR DECLARATION
Thereby 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 it in full force and effect.
License # Lic. Class Exp. Date
&)7117 �`R 10,1311120(
Date ' 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
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 Policy No.
•`i 1' a'i'ls I i fFdl.z 44T.V94910c,120
(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 Section 3700' of the Labor
Code, 1. shall forthwith comply with o`vi
with those prsions.:•--!
Date: Applicant
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*'d 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 representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) " Date---
0
ate • '
BUILDING PERMIT PERMIT#
DATE / VALUATION LOT �i - TRACT
,I
f 45!35
F*��31i.s5Fi.6
JOB SITEA
ADDRESS 4,41•'x0''1 t A�lsL1 aa. MN d A BARBARA
APN
604-381...002
OWNER
CONTRACTOR / DESIGNER / ENGINEER
OL1111-IANITAND WILLIAMS ASSOC,, INC.
C►L1PPANT AD WILLIAMS A. SSC., INC.
'77 =I!T
;0t+-9 (10 A b'ENUE DI' t'f I STA "C`E`;
PAMM FSE'RT CA 92'211
PALM DESERT T � ;A ' 92211. f.
031A 520:3
USE OF PERMIT
SfN(.it.di 1-•.AA-II'LY L►bV.ELIANO
.FFD- LCIT 10 PLAN �' - BL:01, KA1AtjJi
I fxx.
TRACT CONSTRUCTION 2,293.00 SF
PORCH!PKI. 0 I:20 (A) ..F
OARA.GGC:LRI310RT 6 48.00
IUSTIIWATED COST OF CONSTRUCTION
8''EsdiiUT F`CE SvMMAW
C0148TRU PON FEE 1014)00•418-000
P!_kN CHECK FEE." 101 -WO -439-31;8
111 C 4 AN ICAL FEE E 101-MO-421-1)1,'0.._-
ELECITLICAL FEE. 101-0134-4213-000 $150.48
f'i,t NIBING FEE t.01 -000 -419 -WO $10.550
`37'RONG N10110N FEE. - RESBl) .101-000-211-1700 $13.80
GRA[ANG F13- 101 t7iX7 -1Z3-;7(10 8 3.tff;
DE E.1,011ER ING-1ACr FW, 6I.�3ar7.tk)
SU -TO'j"_AJ, COQ iSTR IC1 ION AND PLAN Ct,4 ,('I
a; c,754)z 1.)
1,1;55. 1)1,F-PA.11) VI'I -S
1)1)
RECEIPT
DATE
BY✓
DATE FIN ALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Iasntfzwl�Underground
Ducts
Forms & Footings
81 `S I c=,.
Ducts
Slab Grade
_
814 (4W
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
(fl o
F.A.U.
Framing
Insulation
o
Z3C 0 N�r
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
CA
Cevw---
Final
Final �Q\�
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
`7 .- !
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
r2J Cro
Pool Cover
Sewer Connection
r`Xo
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
Final
Utility Notice (Gas) I O(
_ ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power v%
Final 0(
Utility Notice (Perm) o�
COMMENTS:
Z _ .:jrq:'p : V P: ri.�r ��. - _ C-eitifi., te: of:.tnSuianon -
... '�enTead Fbs I�oYwrNomhehcnin�wih C
-
.- � � - .:�� _ ^' _ f�'�s�9emdta�saaa✓"saner®>oequi�m�:� r� . _ .. _ _ � ...`:,•;
' - � "� ' With Sle•�Cais tLatVgiK lYadg%ihcit a+�-�-ii'�as'imLUeeRltceLtd: • �`
IDSO�ID •' r t.:. _ 'R a: ':�_r•:3=(';moi{_ 14
Y�Y YY6 - .� — •a•-. .VT..., l�Ti" . •LL`•_�"_:... r 3y'1,.. ti �La:!'.i� �! 'a•� i
.•
_rlL�r��'$*psi,'4,3��3�_������4r�''^"„�r`-.,r-`x,�a`.:_.�e
.�- _ r?,_.w'•`WS �106Ifi�i��1fYf�'^'� ^ . l• - _ _ _ _
Pteu�=
un
Sonrisa z T
Se _
'f110-CeQerilsr4Bls�ts
s :►
CS)
411
- r
:7 �p -
-- :a.y
Mrith UAW L#Q�Yt
�qw <•si ' a
T x �s
- Y
l.:
- 'x. - �•!'.� - - "✓�L•J'�Mry•-r'L' �;"- <.•:: mow,. _ cC: .•:G:�
5 _�•:- •^�:'Y _.T�L�i�rW8n8: •"''� BTif[O 3
LO
_ _ _ _
ti•
- Ab.•,.�
ver _
:bx
ZOOM. -it
-
ram
MII
l. :
*■� �. g _
�._
r•n r
ZI
- - .. '•fit
i -
Q
e,o N
_ .y'+ Tom/►1.
-X.
jsam- II ( 607a .Lloese 1011.
ipirle id pw -or
or
vnckita-01ft see
Diriectt r of O etri ng O�'%er
_- -
CD
R -means ane o� heat.
The the Ft valaS tale P��• .. .
A*g p+ ode% for.** fact sham oa, R- vxW� . KeeP.this .'y �
:. _ va11�t[ papers ffyoui wear sM Ws bow tms a0rti6cati s�ild •°II to
CS)
:s
:• _ -
2 ::