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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
Date '`t `�} I Signature of Contractor +1/^f
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).
( ) 1, 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.
1 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:
Cartier Policy No.
MATEM)ND 157602,00
(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 forthwith comply with th `e'p'rovisions. ah
f
Date: r �'., , Applicant -•-•�, /:•
y
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose. request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property.foriinpect+on"purpojses. ,
Signature (Owner/Agent) ' !"�';�1 Date t+�
BUILDING PERMIT PERMIT#
DATE ) VALUATION LOT!{+.°! TRACT
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11+5 2,8490-7
JOB SITE f"
APN
ADDRESS
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OWNER
CONTRACTOR/DESIGNER/EN (NEER
MEW , � X) :R(DUKES
SHU N IMUM
5400 C.f�.i a'e.'�AVIENM 59TE 125
3400 04"N.Wi L PW11:�NzfE,IFI's 225
(UVRM 01 CA 92506
15 YRRISIME CA. 92506
CPU$ -.11386
USE OF PERMIT
040 24, FLAMLY 3;3 M;,1:.DTO
SF -Vv PLAW31 R.!_,Z)T;_N& PIS MIT DORS NOT 11dttiLUD&
t.43,OCKW:AIi ,F,�OOOC3Y. DR.IVKWAY APPROACH. 75% MAN CHECK PER
REDUCTION POR M1I181PLE MUANC H, OF DAME PI A11 TYPX
CUSTOM f;CiNST RUCTICM 3,102,we SP
i?T3at1:`?dPA`PIO 3M.00 S,P
//�*:,//pp��gTT�''�° tp�y /yI �S /�{�pp pp��( fA��� !6
S,i�,�194�•. TTa�iV`�a��MA C'2i]'.,i 101 "'000-41 S`"OW %JI iJtl; 0
PI.E1.'ta {r'i9IWK FRE 101-000,439-318 $243.'�Q
M,EC'FIANX,'A FVF, 191.00(M21-000 $4E150
iTX,.kZT11Ry'CAL FFF, 101-000-420-000 $173.91
PLUMMING FEE 101 -000 -419 -WO O $ S=
MUNO MOTION tFKZ - MID 1014M3L. • 241-000 $0,X1
O AI:INO.WE 101-00"213-000 120.00
1NY AMUCTIg}, , k .L 225-000.443-342 $x,gtam
ART .1'N PUBLIC PF.. MS-11FSIE 701-000-255-000 $12 3.30
SUB -TOTAL C0341=47 M. ON AND PLAN C21MM
$3,qw. 16
F01 :FRk- ;'ATI?"
$0.00
'.1Y.3?fAL PF -PM :r 1+M$ DUE NOW
RECEIPT
DATE
�BYI f /
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
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
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel .
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
_
Waste Lines Z Gl_ d(
Water Piping
Heater Final
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:
SEP -13-01 12:39 PM 74E4353 7603240131
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CITY OF LA QUI A..._
BUILDING 6 SAFETY DEP MPT
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1/ INSPECTION REOUES5INC U
777.7153 LL m
Owner HOMES Q
Contractor SUFFIEfELD Hr71VLS T. V
Permit Number 0101-186
POST ON JOS IN CONSPICUOUS PLACE
INSPECTOR MUST SION ALL APPLICABLE SPACES
JOB ADDRESS 79-840 CITRUS
SFD-PLAN 3CR LOT 56 -PERMIT DOES NOT INCLUDE
BLOCk'WALLS/POOL(DRIVEWAY APPROACII,
71YPE OF INSPECTION DATE . INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL l�
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB -
JOISTS 8 GIRDERS
ELECT CAL GROUND WORK
i�,G S• j
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC ;
HEATING 8 VENT - A/C
! FIREPLACE
ROOF `a
BOND BEAM !
O.K. TO WRAP
GROUT D 4' O 8' ;
FRAMING
INSULATION p i
PRE -ROOF !
COVER NO WORK UNTIL AGUE HAS BEEN SIGNED
DRYWALL INTERIOR I -r/ rye 1,,tc'P-A
POOL PRE PLASTER
POOL FENCE d GATE
SEWER SEPTIC TANK / e/
FINA
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
P.01