0012-079 (SFD)LICENSED CONTRACTOR DECLARATION
ujyI hereby affirm under penalty of perjury that I am licensed under provisions of
F= Chapter 9 (commencing with Section 7000) of Division 3 of.the Business and
Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
r- C)
I,- W 78750_3ISIF1iC '11�3(!�(D'e
oZco O � Date G J �7f4� ,Signature of Contractor�-"^� _ `���''t
J U OWNER -BUILDER DEC,L1. �ARATIO\
W a I hereby affirm under penalty of perjury th fT-am.exe_ mpt from the Contractor's
License Law for the following reason: '"
Z_ ( ) 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
LO
N Date Signature of Owner
O�
Q WORKER'S COMPENSATION DECLARATION
j 2 Z I hereby affirm . under penalty of perjury one of the following declarations:
HX () I have and will maintain a certificate of consent to self -insure for workers'
K uJ. � compensation, as provided for by Section 3700 of the Labor Code, for the
D
J Q performance of the work for which this permit is issued.
Q.0 (i)- I have and will maintain workers' compensation insurance, as required by
J U Q Section 3700 of the Labor Code, for the performance of the.work for which this
1 LO .� permit is issued. My workers' compensation insurance carrier & policy no. are:
'I z Carrier,_ Policy No.
J(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 soas to become subject to the
workers' compensation laws of California-•andaree',that if I should become
3 subject to the workers corn pe�nsationrpprovisions of S ction 3700 o the Labor
Code, I shall forthwith comply withs ose pro isions.
Date: 1, n'.>Applicant .�✓' �
Warning: Failure to secure Workers' Compensatibn.,coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up.to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject .to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of • issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby .auth&i a representatives of this City to enter upon
the above-mentioned property for inspection purpo,::
Signature (OwnedAgent`: "-/ ` '�' Date
a BUILDING PERMIT PERMIT# `
x,:
DATE VALUATION LOT (101"79 TRACT k .}:.• .`.-
I 2A 24UO LOD '73, 74' 'ani. &X31.150
JOB SITE ry
ADDRESS
APN
OWNER'
CONTRACTOR/DESIGNER/ENGINEER
BCK Via,'+ffi�i'larr GROUP
I DAG CONSUVrING BM 'S
PA DOX 1490
P.O. BOX 937
LA QUINTA CA 92233
1A Q(WW, CA. 92252
(760)771-23114 IcXdtl
USE OF PERMIT
1WC111, FAMILY DWEELU G
SUa PUW.ZNTA . TO PERMIT PW7-5n SHOVANO CHANuS, 01P dON RAICTOR .
i
CO ►>x"r Ok" Q:0K.VMTJC.'° O��i
O -W
•�y� �'y��j'@� Q�g��pa (�=��•g11pTA'13VS&'�'ED
XZ'T$ilYAdil. b- Y �w7i3A-r.Yd.J'd.7�eR
Nli3 ii.LAAt�tt7ta 101 •(3013")423-000 , a!
QL_C`l;�
gUB-WrAL C0_ N3 btU(, 10 WAND PLAN (: UZUK
r $4.50
�
` LES PRE -PAM FES J
$0.00
I OTAL Tt 1fMWV VUS DUE NOW
$4.50
RECEIPT
DASE
BY
DATE IN b
INSPECTOR
G
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
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
a li o0
Final
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
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
p
Appliances
Final
COMMENTS:
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)
cupancy
Certificate of Oc
City of La Quinta
Burl-dt.and-Safe tlDi epailmenh,
ty
of Uniform -B
This -certificatb issd & qfldijgCode,,
e,, pursuant to* the reqqirements�-of Section 1019
cir#fyin_gt40t, at the time of issuance, this structure was in.compil ce with the: various ordinances.
of the City regulating MA)ding, cons' tructiodoruse. For the following::'.
BQILDING ADDRESS:. 50-625 C,ALLE. PALOMA-
Use Classification: SFD Bldg.'Permit No.:, -0012-079
Occupancy Group:: 133' Type of Construction: -VN Land Use Zone: RL
Owner of Building: BCK INVESTMENT GROUP
Building Official
Address:
P.O. B.OX 1490
.City:
LA QUINTA, CA`. 92.253
By:
STEVE TRAXEL
Date:
05 -07 -01 -
POST IN A CONSPICUOUS PLACE