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I hereby affirm under penalty of perjurythat I am licensed iiridenprpvislons'.�V�'�
I . I
Chapter 9 (commencing with Section 7000) of Division .3 of the Business and .1
Professionals Code, and my Uc6nse Ii 16 full force and effect.
Lic. Class
ucense # . I . ". ., � z .
E)O. Dal
69711'7 B MC
4
Date 'Slahattini Of ContractoA;Z_
, j.
,OWNER -BUILDER DECLARATION.
I heriby affirm, undeii:kenaliy of perjury that I am exempt from the Contractoeg
License Law for the following reason:
1, as. owner, of _ft property, or my. employees with wages ad4heir able..,
com0ensation,IwIll do the work,. and the structure Is not Intended or offered for
iale'(Seci'7044- Bbalress & Professionals Code):
)".11, as.oWdeh6f!the'property, am exclusively corltracting.wIth licensed
contractom.to constfuct-the project {Sec. 47044, Sudiness &.Profeselonalb.
OAil
I.Am exemptundev action B&P.C. for this reason
Signature of,0wrter,;.1w
WORKER'S ,COMPEN DECLARATION'
COMPENSATION
nder penalty �of�oerjury 0n6. of the' i - ,
a consent t6 self -16 ur6 for4iorkers,
,;I have Ii�d -a certificate of ant 8
compensation, irdvIddd46t by-Se'ction'3700 of the LAbor C
,pensaton, amp, ode, for the.
rformahc "of the workloPwhich this,permit-IS issued .'
willFmw
�ho:•and, htilnworkers' Com;%nsatIon li4sur4n'ce,'aS'r;q6ir�e6 b
y
'�J!4ctioh;,3700 of the. Libor -Code, the'performancie of the work for Which this
".1',permkis Issued. My,'workers' compensation Insurance: carrier -& policy. no. are:
Policy No
"467-W
Owl 20
(This ge&IJIon,need not,be.completed 0 the permit valuatioh'Is for $100.00 or.6s)..;,
su
(,1,)".`I'6ertIfV'that in the erfdrmaince:bf the work for which thls7'permit Is Issued,
6d,'
:1 ihall:not,,employ'any pemdii in any manner so as to become subject to the
INOrkO'rS''compenigitio6'la��s-of talif6mla, and. agree that)f 1. should become
subject to the �v'orke'�'r's*'."com�p'"e'n*sation provWorI6 of SedtI62..3700.9t the Labor
Code; I s yypdt with comply w�lt �ho � 0�rdi
bate:, .'_ApollcaA
.'l.WnIng:. F'all6re to secure -Workers' Corperisation coverage is.uhlawful'and
shall subject an ernplo`yer'tocilmlnal penalties and civil fines up to $100,000, in
tor
."Oildit.IOK .� the Cost oic'ompienisiatlon, damageias provided for, In Section 3706.
of the _!.Abor'Code�;, interest and attom6yd fees!
IMPORTANT Application is,t�ereby.rha'dd to ih; Director of B6 Ildlng and Safitly
'"I ondition' and restrictions . set forth on his'
for;,a!perrn t, subject I;to,'thdl'.c s, n
appli6ation.,-1.
Each persi;n 6'�dn Whos4.-behalf this application Is made & each person it--.
A; ' work 16'
whose request an0or w4ose benefitwo performed Under or pursuant to,s
any permit Issued a- reWlft of this applicaton agrees to; &.shall, Indemnify
b,'V�hbld Harmless th61C4.,'6f'La Quints, Its.offlcers; agents and employees..
, I , I _d� . , 11 of',
La
Issue as a result of this application becdmei null and -void If
ll,IT� , work Is I not commenced within 180 days from date of issuahce pf'such
o , r ce6sationot.4;ik for 180 days will subject perihit to cancellation.
Ji certify that.1 have, read thIsAPP1166tion and state that the above informati6nis
correct: I agree to'complgWith all City,' and State laws relating to the buildih4".
","Const'
ruction, and hereby authorize representatives of this City to, enter -Upon
the eibove,-'mentioned.otop"e�',O:for-insp ctlo-n pure as�d'
Signature :(Qwnei Date
E
SUILDING PERMIT`�-)
A
'14 -,k
DATE ;4'_4 VALUATION ;j , .", . 2. TRAV,
IJ�
2595.3
Jos SITE A".
:ADDRESS
4 IN -
OWNER
CONTRACTOR/ DESIGNER ENO(NEER ,
t
-,77-9oo.AvVMo:P11M3LkM
71-900AvEi-moFTHE;mTEP
,.ilk".DE8.1£R? CA 92211
PAW DEMT :,CA 9221.1
(760)345-2626 CBL# 5203
USE OF PERMIT
MHOLE FAMILY DVn9J_WG
SM -LOT 24 PLAN 3B PEP -MIT DOES NOT FNdWIiZJ3LOCK WALLCIR
TRACT CONSTRUCTION 7,M.r,f
POPCHIPATIO 170.00 V
-.0ARAGEW-A"ORT OF) IZ"4.8
-J
01, .
KnWATED cour or cONSTM ,
1. `t.,L to 1384MAO
FERAarmsummARY,
i
C043TkICT1614 IIE l01-000-41$-000
PLAN CHECK FEE, 101-000-439-31V,'
Y,s
"
MECHANICAti., 21 00 66 50,
:101-000.421-000 A
ELECTRICAL FEE. 101.000-420-000. _$150.48
PLUMBNO Fix 101.,000,419-000 , 'SI69'so
MOTION FEZ - RESID 101-000-241.000
.3TRJD00
OPLAIDINO PER '101-000.423-000 ixoo
`.IDXVELOPER IMPACT YZE
BOB-70TAL , CONAM
MUMONPLM
$3,754.80
LE Pim-PAD 1
50.00
-LED DV 4(),W
RECEIPT
DATEI
E FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
IR
Underground Ducts
Forms & Footings
ILi
Ducts
Slab Grade
1Low
Return Air
Steel
1
Combustion Air
Roof Deck
Exhaust Fans
O. K. to Wrap
Z
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWALL AP ROVALS
Final
steel
POOL ° - SFAS
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
_ C
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: