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LICENSED CONTRACTOR, DECLARATION
I her 'yLaffi,rn 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 affect.
License # Lic; Class Exp. Date
52,1983 . - .. . C-53 01,28120i
1) t6 I_(L Signature of bontractorl ilh-1
V -
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that'l am exempl from the Contractor's
License Law for the following reason:
( ) 1, at 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
Salo (Sec. 7044, Business & Professionals Code);
1, as owner of the propertyi am 6xcl.usively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
I aim exempt under Section
B&P.C.. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury bne of the following declarations:
I ( ) Ir hay.e,and will maintain a -certificate, of.consent,to self -insure for�workers'
compensation, as provided for bySection 31700 of the Labor Code, Jor the
perfor ance of the workJor which this permit is issued.
i haveandwill maintain workers! compensabon insurance,asre by
I
. ( - , - I . . quired
§�Zn 3700 of the'Labor Code, for the peirforman - cis of the work. for which this
permit is issued. My workers' comDensation insurance camW A policy r1q., are'
C aqW Po lic y No.
ffhis�section �need not be completed if the permit valuabon is for $100.00 or.less).
I certify that in the, performance of the work for which this permit, is issuedi
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
Coop, I shall forthwith comply with those pi6visions.
Q
V,Alte, 4ri - ----- Ar.e -.. I �D' Applicant Aqp 46t, "4d rk—, F–.77'r 1 t:..f4 0–
Wa
yrling: Failure to secure Workers' C6mpensation coverage, is ' unlawful and
shall subject, an,employer to criminal penalties and civil fines:up to $.100j000Jn
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 be -half this -application is made & each. person at
whose requestand for whose benefit work is performed under or pursuant -to
any permit issued as, a resultof 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 4
work is not commenced within 180 days from date of issuance: of such
permit, or�cessation of work for 180 day&WIll subject permit to cancellatiom
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 hereb authorize representatives of this City to enter upon-
/th 'above-mentioned prope for inspection purposes.
Signature (Owneir/Agent) Date C -d
PERMIT#
BUILDING PERMIT
1)909-117
DATE _W)VALUATIO1 TRACT
09 ,v),fflm'.G0 LOT
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR i DESIGNER ENGINEER
%A f, I I Y SVY7 �1 1, A A 1.7
t "IT R (T
MftA32 7
_52-470 VEL 6.1VF0 DRIVE
7508 S'P. CHARIX
'0 , 'S PL B
LA QUI -N -1-A. CA W i�52
PALM DES E. kT `A �0'
(wQi, 8 -oh C-Itfft :�71
USE OF PERMIT
KX)L ANjDi0-k.&(,, A
POK)L CGLY WiT10Jr%A:115R' NO SPA. IN,
PLACC AY PR16-PLASI'VX INSPECTR>N
POOL A,ND"CAR '"'PA 20,000.N) 41.131
0? t
P RKrAliff FEE,
sumgmfv
Pl.,AN C.Hf_ZCK Ha, 1014A)0-439-.08
�ILX'711A�41CA.L FEE - - 110(A, 101 M0421-010111
1J0'r.A.1, C('JNSfV;(P0N ANC) PT,,AT%1
PRZE-PAML FEES
to, 0,
T.OTAI., VERM11' PECS,0111F, NOW
RECEIPT
DATE
BY 'k
DATE FINALED
INSPECTOR
I
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
0. 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
Final
BLOCKWALL APPROVALS
Steel
POOLS -SPAS*
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Local ion
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
Encapsul ation
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
Extedor'Receptacles
G.F.I.
Smoke Detectors
—Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: