9910-204 (SFD)LICENSED'CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am' licensed under provisions of
Chapter 9 (commencirfg 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 € 05112N
Date 4V_1_,d/e4 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.
(\`l� 1 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.
STNIT
(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 3.700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: , ` ' er Applicant 4W
WSI ning: 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 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.
Sign�ture (Owner/Agent)"Ie J �1 ��r Date P
PERMIT #
BUILDING -PERMIT
990_24o4
DATE 1 VALUATIONi. e LIQ LOT; 6 TRACT 25951
JOB SITE
ADDRESS 44410 CAUE SANTA %#EAR ]APN'
6(9-3914M6
OWNER
CONTRACTOR/DES�IGNEER / ENGINEER
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104YP
OL%iA:6i.iry.r Cdr.
i"7_c3 0 t� V1.t�I(11 C?I^ k'I 1 S'Tr�
77-900AVENUE OF IT1E S i'A1' FS
PALM DESERT CA. 9221t
PALM D1--,SERT . CA, 92211
(70)345-2417.6 L~13Ut °320;
- -
USE OF PERMIT
5rtvrar;,�
TWD. LU:f PLANICA P f�1' 13Gli�,y vC�T iAiG'I. L � .C3�rr? A t Cj.R
404; L.
IRACT Ct.iNSTRUC710'N 2,210.00 SF
PORCt ATIO L30-0019F
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ursuxxvso mn- off'
PERIVIT Y -EX SUMMARY
!:0NF1YkUi: 1(__) d FHE 1014X3041& -QW S761401
&1ECIIiAN-IS A: r M- S53.50
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ELWO-FRICAL FM .40i -M420, $14*17-91.
Pl.lNIHINQFRE, Q1 ;1 4i� (ice" $1454 F6
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Rlff ()a4Yi(3nON FW7% F, - RISfrJ 101-(/(�W24^ry1�*t
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GRADRIG rif-
AWf IN P11JOLIC PLACES
S"1.JFi-;` Y AJ,CO3N'S7TkUf."':T- N AND P1,.A.N CHECK
S-1,791.63
LESS PRE;-PA101.FEES
RECEIPT
DATE
BY �� '�
DATE FINALED
INSPECTOR
C�
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
"L
Return Air
Steel
Combustion Air
Roof Deck
7� . -a" ,_CPO i _
Exhaust Fans
O.K. to Wrap
, . 0 6
F.A.U.
Framing
�f . Z -Q® _
Compressor
Insulation
S - z - 00
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
5-12--00
Drywall - Int. Lath
5 . a't-cam
Final -
Final
q_� ao
POOLS - SPAS
BLOCKWALL
APPROVALS
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
I— to -C6 (
Heater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral.(Z
Pool Cover
Sewer Connection
_
Encapsulation
Gas Piping
Gas Test
8.8 E1� CO
Appliances
Final
COMMENTS:
Final q_I
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) Z (Gid
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Certificate of Insulation
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YoHome-hu been insulated with Cerra mTeed Fitiasvlatierglasa iM gmductS, which are designed
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for todWs. saWsiandards and toffiOMIRN eap reC�1ICnfCH�,
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FlNnP ss is inoripamcand theaeface p�enna�e,iy noncuadwt'rble, so it does vb not hiito iie gated
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v�ti► fue-rdardat`Cheils:3>taE-wi[l litwy l their eteciveess civ come. It bas natlieen treatad
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wuh dizioiCaLS *at caarcarzOde wamg oI! l Floe ass ol�,ii not absmb and mre nor will It
settle aver time as may tdw insulahon materials`
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This stab certifies.dig CwtainTeed Fiber- Glass Insidation has bains4s='pmhfes ily w is this hnmc
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to gravida �e fiollawingtb'eia�al"pedbtmanac,. --
Job 1%10111� Sonrisss Tem 25953 Pion 2 >p6m: 3
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Let Nm: 6 Job Add;esa:.4,t4W,Ca a V'idz'Sartm Le'QKmt -.CA
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Ceilnpg AieA: R-36 Uiaoed Gara9e'Ce�6ng
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Rxeiior W#IIe`R-l3. tTndaeed'
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Party V9aila:
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Subcontractor.. OJlAMA00it fes, I
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Signed; .'
ironiAik'O"14 Mecretwvmreamrer -or—. K Scott. JenAiAs,.Fnesident -or
iLou'Merola, Director of Operations.Offlc r
R -means resistance tobmi tiow. The higher the R value, the greater the insulating -power.
ASIC your builder for the fact sham on R- valves. 'Keep this =ti6i:ate .with your other
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w hwd papers. If yme ever all this Home, this oe�ficate should be gassed on to the buyer,
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