0211-129 (BLCK)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.
License # Lic. Class Exp. Date
744,091 1!3 12.131/3.(
Date`/ '� Signature of Contracto x T
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.
�,. ) 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 STA7•9FUND Policy No.
(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 3700 of the Labor
/Code, I shall fprthwith comply witht ose prov' 'ion s--~•
Date 1 � -" Applicant � e'
Warning: Failure to secure Workers(Compensation coverag 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.
-Signature (Owner/Agent) A /,A � Date✓/ I, *-Z-
v f� �
BUILDING PERMIT PERMIT#
DATE I�t/E VALUATION0,5744W LOT TRACT
1J1(
JOB SITE
ADDRESS 7849,10 MMITS,
APN
I - -
OWNER
CONTRACTOR/DESIGNER/EN INEER
Ui1 'VIS ix 1;51! � T,G(�1 1ri`T CIORP,
a -W4 SI. ADEVEICIPW- T CORP,
PG BG3( 1144
PrO PR X 11
L,A,QUW'r.A GA, 92253
TAQUINTA CA 9=3
E� (i(}�77 Y •�17? 2 CpI32� a39 f
USE OF PERMIT
105 LAr n' LOCA t: 'WALt.d301..1p 5' 1;I C -1K W.ALLJ40 LIF L..M'S 7'KAN
'36'.8 LOC K i°d,F LL(COLFR.'F°tE•FS`t`C INSPECTI Q/112 ` 0 ,LFNF FOR
FUTI"4BlUf APPROVZOI S'TA11117A1k.1)..
6 Fr. i/3?� 00 LF
4�1�3F�.a 0u,
5 TP,% tlY .d,, 30. 00 1 J?
RT) �. osr 4113y �r4a'A [Il ffi, a.0.S.f 6r�d �C.i, 17
3,574,50
••�� ^^�� ��yy� ��yy �1 �^�•�y d •.;� g /� �8yeyAy7.IC�i."k'a1R�A
t:(7A13"�'ll�lK:'1'IC�;d 7rizry 1 t?3 „4}C3�k41' ��C1.L� �6�,60
PLidF3g' !N a 1'' .vp, 1111 -000.419 -POO $111.00
f
NOV 1 R 1
CITY OF LA QUINTA
FINANCE DEPT.
• :,X3j PRE-PAUD FEM
$0,00
TOIAL PERNMI,PEES ]ATE "W
$91:.00
RECEIPT
DATE
� 1_ /
DATE FINALED
INSPECTOR
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
0. K. to Wrap
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
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings [,,Z
Main Drain
Bond Beam 6 O
Approval to Cover
Equipment Location
Underground Electric
Final I %y 67 1
Underground Plbg. Test
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 r-% -5-
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: 136`
CITY OF LA QUINTA .
J cFM o BUILDING & SAFETY DEPARTMENT
_ 777-7012
INSPECTION REQUEST LINE
0TY OF t_ ____...__ _........_.. `777-7153
FIN K, 'SIJN V— STA DEVELOPMENT CORP.
Owner
Contractor SUN VISTA DEVELOPMENT CORP.
Permit Number 0211-129
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
78-810 CITRUS
JOB ADDRESS
105-1,F 6' BLOCK WALL/30 LF 5' BLOCK WALL/ 40 LF
LESS THAN 36" BLOCK WALL(COURTESY
INSPECTION)/1/2 " GAS LINE FOR FUTURE APPROVED
APPLIANCE. WALLS PER ORCO STANDARD.
TYPE OF INSPECTION DATE INSR
TEMPORARY POWER
SETBACKS
U/G PLUMBING /WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
nUUr rvrvL / rnc-nvvr
OKAY TO WRAP
FRAMING COMBINATION
oni iflu M rnroin
HUUUN MtUNANIUAL
.1.. n. a —^-
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
-MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
fTzfewt7 "" V 2 -.2: /7-�--- I
POOL / SPA'/ WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT. ) .
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY,BUILDING' .