9912-197 (SFD)U)
H
_N U)
w
Ouch
r` O to
W
o
Z
(c)0o
JV�
W UJ
F- d
U)
Z
co
Ln
N
ON
U rn
a Q
It Z
r Q 0
0 J LL J
mQU
d o
aiac
)
q14- Z
co Z)
r� O
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
i1•iin' i$ f, 10ia11"01
Date Signature of Contractor
OWNER -BUILDER DECLARATION/
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following ieason:
( ) 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 %t GLC 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 forthwith comply with those provisions.
Date: / a (�- Applicant
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 for inspection purposes. ( _
Signature (Owner/Agent) 'I'y Date + �'
BUILDING PERMIT PERMIT#
W)1t2437
DATE VALUATION SM198.60 LOT 62 TRACT
JAN 0 5 2004
JOB SITE i1'5' ••'58'5 COi�S.AB�i'I�i7K. LANE _T
PN 66"40-016
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
('0,;ri', C, !s
C•f-N!"I:N.:` Cf�L:.'r1:G£. CO:�9h3IJTJl'RES
iJ s? e5t"J. "Or X91 L 1i' S 1 C. lItGG
1535 SO. IT! STR..r.l? f, -M. 9200
S1W ki1 kNAlill1NC) C'A IY2408
SAN 13E NARD1NO CA. 92408
19691391-6007 C13 X 2120
USE OF PERMIT
SiN+JiI.tJ 1'Aii[%.4 13�.Ir�14 s
aHJ-LU14>d Y'LiV,44lilt- i%l: AVIL I L" J.Ub 1401 11v�LUUb 13LVt_;1S. W111.L (A(
1A,4&L, /51.14k, ( N 0.►4f?i.;A:XW)(A'1/JN RP1'LIEL) Y(A I LIL'i'1} LE,
8UJ]l .It1' I'AL
'TRAC T C 014iMU 1171 ,; 2.2G0.00 -F
T RCiOil.TiO 22A) SF
6.vAltAC�3srl;tal.<i't3fi'�' 1533.t1t1 �)s'
ESTIMATE= COSH' Off' -C3NSTTC:'�'i7A0N
321111MOA
�� %y�TR� Ia
y� pM�. gy.� 1�p'�y PER
Y.•R:IT.w.A �.A, .RIV.V R SIU`•l.l -fakk9:
t:;OtVS'.1'WG;1 QIN1,}:1? 1014,100-41t.{-O(YG 3755.00
PVANC-H-W7f:, 37FR 101-000-419-31f2
F•1^� 1 9 11 1 ,f1I @4'� r`,
ttA4M.l lksLL: .b ni,. k 7.:i3 IO't-009-421 0100 131, C4
EL:IC-CIM CAL FEi3 i0i. EiiJ%-�i24>fit?(1 513�.�2i�
_
PIXINff311vTC➢F-EE 101-UL0,4.19-000�r,
S't't7n'Ne r »rrCYr1t?N 4"i;Ti - Rl,ztl t 10141 )f)-241-Ii)(j
1+iVX);*N,,' re'a- 10.1-000423-0100
1`r1?,vtsi.t�Nitzflb�,t'J#LT'k'ktt; �;,yt}7.U(J
f'•,� : . ; 1,
AFt`.1' 94 PUBLIC PLACES ES - Rh,81IJ 7111-00(}-25.5-000-
tAj
iZSS PRE -PAID 11217
S(!
'i'O"i'A.1, .5'1r;3tAPoi'L" FEE -004 04% NOW
o2 0!.52
RECEIPT
DATE
BY j
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
2-21-00 K
Ducts
Slab Grade
Return Air
Steel
1-tt-pQKJ
Combustion Air
Roof Deck
3..
Exhaust Fans
O.K to Wrap
S - -00
F.A.U.
Framing
. C G e
Compressor
Insulation
-t __tF_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall'
Exterior Lath
'7 -.7 -00 . 6 if -
Drywall - Int. Lath
7
'1Vv �.-
Final
Final
!1 -�( eo
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
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
1 -I -X- oo
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
G��-
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
_
Gas Test
_
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)