0011-287 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby 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 is in full force and effect.
Lic Arse # Lic. Class,- Exp: Date
r �
67£C 56 C-61 D03, B r X i9?� 1l2t
ate
Stature of Contractor`r�
OWNER-BUILDER.°DECLARATION
I hereby affirm under penally. 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.
STATE VUND 0460-'0141T 07749-90
(This section need not be completed if the permit valuation is for $100.00 or less).
(
),,Ice ' rtify that in the performance of the work for which this permit is issued,
I shall nt employ any person inany manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
sub'e'ct o th worker,s ' compensation provisions of Section 3700 of the Labor
de, I pha Ifo hwitfi comply with tho e,pfov}siyns.
Date: I Te' � APPlicant . /A
U V
Warning. Fallur7' 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.
�u
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 aII,6i y,.and State laws relating to the building
construction, and hereby authorise representatives of this City to ente , upon
th/bove-mentioned property for inspection purproses.
6'gnature (Owner/Agen j•• Date
BUILDING PERMIT PERMIT Jt
DATE'-' i ` , ` VALUATION LOT 4 TRACT
1 y t"jo= W,07310
JOB SITE
APN
ADDRESS
44-875 'C'l!.T.. SAWTA ,RR&RA
'
_ _ .
OWNER
CONTRACTOR/DESIGNER/ENGINEER
44.875 ACAL LE. OAANTA BARBARA
754 VJ1LJJAW, ROAD`
Uk (tkYINTA CA 92253
PALM :SPRNGS. CA 92264 -
t
(7 60Y327-8466 C-BIA 1825
USE OF PERMIT
PATIO
-
LATTICE PATIO CpO�fry�RR PIM =154;0902621 PIT ..
gAy1.Ubfi>AW�iyi0D
If?'xlTh8`44 •Wf3ag iiE&DF.R HFAM'Wtl ADD POWS.
PORCH/P,A`P10 M.00 :_9F
Fn HUMM.ARIA?
PLAN CHWK fTEE 101-000-439-318 S".30
CONS` ICUC a ION FEE 101-000.418-000 $10€3.011
STRON0 MOTIO14 FEE - RP.SID 101.000.241.000
s
ne A
k
I� AL CONSTF1,13C T1014 AND PLAN C .TEM-`iC
1.1311) PRF: -:PAID M0
NOV 3 0 2000 T6TAL MOM FY -ES DUE NOW
$179101
' +
RECEIPT
DAT, ',
BY 1 �
DATE FINALED
I NSPECTOR
(t _i�J1Ji.�L)
1! I
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
Root Deck
Exhaust Fans
O.K;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 Firewall
Exterior Lath
Drywall - Int. Lath
Final —��
BLOCKWALL APPROVALS
Final
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:
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