9910-192 (SFD)LICENSED CONTRACTOR DECLARATION
I.hereby'affirm under penaltyof.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
697117 S / _ i41f311 4t
D\te /I Signature of Contractor'
J
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
bate- 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.
N 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.
STATE FUN
(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; I shall forthwith comply.with those prove ions.
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 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 notcommenced 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. 1 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
f
Sig)rre (Owner/AgentDate 0114
=BUILDING PERMIT PERMIT #.1
993
DATE VALUATION.$14, LOT TRACT1101q
JOB S
S 4"1.154"1.15Ck�.Ii.U, SANTA Iit'•,'tslWARA
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
r1..1PTIAW ANE.) la ILLIA.NTS ASSOC.,INC.OU�PHAr%rr
,,Ni) ��i�.�llAld1� ,�,SSOC..,1NC'..
77-900,e'�,VENUF OF'd HE ;S I'.r�">`ES..
77-900 AVENUE OF THE a'!'XrES
1a.ALI1 DESERT C.A 92 11
PALM IDESEXI' CA 92'x11
(761)'345.2626 CRIA .:5203
USE OF PERMIT
S.IiVFOI E. r lAA) fLY DWE;,fi LING
SID -LOT mac, PLAN SCA'GAUirr DGES NOT WNLUDE RLOM W4iL t' R
W-K)L.75% R0_')UC 1'1CV ?'`EE ON DAUL R lPLE 1W1JAN( 3 OF SAW PLAN'
nbILC , CONSTRUC 11014 2,480.00 MSI'
PCvTLC;4$1PATiO 788* SF
t.,TA#ZA(: FJ� A£2Y �S2'F 656.00 SF
R4a�i A'LO,Iih 969i.0i COST Off CON S.LON.
PM%111'f FEE Si3Mt1t%t9►RY
Ca)KSTRLUC"•TIOWFEE$ti11.00
-.
PLA NC1151C 1;4° 101-0(36J-4 -31 51 i.9§t
X11Y.11ANIC..A1, FHE 10l -00th z # -(i00 %0.00
F:T.Et.:rwcAL to.--oco-42"oo $143.42
t�r..6mr iN 31k 101-t3UU-419••UtIt1 $10.00
-•`'
Fr.tRoNn I.moTiKo N FTR - I2:ESED 101 -MO -24#• -OW $14.86
-.
UbWINQ H M 101-030423.000
A .T IN PU;B1.IC PL.ke&% - RESIC 701 -000-:L55_000
WI3-!T)T A�, C'ONS'i'I~ f_ftM331,,1 AND PLAN C-11 X
$3,410-67
LESS PRE -PAID 1^' EES
$0.00
TOTAL. PERMIT FIXES ME NOW
30,410.67
RECEIPT
DATE
BY ` -
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
1-Z2 - oQ b(
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
�- %3_ /�
Compressor
Insulation
- Z-1- p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
S 3
Drywall - Int. Lath
AV
Final
8
' oo A
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
l2 _ gyp— �.
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
COMMENTS:
Final
Utility Notice (Gas) J C�
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)
i
Certificate of I su ation
Your H=C has beeTrinsvlated with CertlinTeed wh
Inadatim p[od=14 which me
fely d omed
for todWs sift sm—dards and tomanxiws energy nequU mem.
Fibmiglass is inurpnic �nd dwiefte mmanenlly nauaombasWale, so Ti dam; not hmm to be taeated
with Eme-zeandaat che�n i s,that will WQely-lo®e *ar7m time. It itis got bash anted -
with rh rmic-alc that; can GOQrOdC waing or metal, bagtaw Will' ha absorb midame-nor wiN it
satile over time as may other iiisidatian matcriAls
This also ammffies that CelsainTeed F bcr Glass ITirtulaRion has been gmfessianAlly iaatailed in this haste
to smyide ttte follawiagthenal Pedo an -
Job Name: Sanriea Trst: 25953 Plan M
Laf Nac . 64 Job Addiie '"MS Calle VTata Bats, is Qninta; CA
Ceding Areas RAS.Unfted _ GaT Cd .
' WiotLlLiv+ag Abave .
LTterinr VHaft' e ExteriorWalbr. R 13 (Infaced
.Party Walls. VVWL mg Above
(3 LUM) Gq garters:
'OtJl tl[XO_l O.r fnS7l Oil Ca, ize
vmoant. Hama COs917a2 (00612w70 traasM
- 1. -. - -_ %, - .. . .1"k . . . .
Conchlita 'Orft Secre[ary1Treasrerer —or .R ScottTehmns, Pr"&kd d Or=-
Lou Meroft Dkector of Operations Offlcer
R means resismnoc -to heat flow. The higher the R value, tbe' Beater the inmilsting power.
Ask your builder for -the fiat sheat an R vabm, Keep this QgdfiaW with yaw other.
valued papers. Nyou ever sell this home, this ant icale should be passed on to the buyer.
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