9609-147 (RPL)-- CONTRACTOR DECLARATION- . - -
I herebyy of perjury that I am licensed under provisions of
'Chapter Pnci,t'hSection 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
ate "' //Signature of Contractor--
OWNER-BUILDER
ontractor OWNER -BUILDER DECLARATION'> �'
I hereby affirm under penalty of perjury.`that I am exempt from th 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 AiX.?3 M�'wo�kers' compensation insurance came`r�&`�'olicy'no. are:,
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner`soas to become subject to the
worker`s' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
C96e, I shall forthwith comply withhhose provision
pate: -tel Applicant �.fliyyi :+ v� .r
AY—
Warning: Failure to secure Workers Compensation covefage is unf'a'wfulland�
shall subject an employer to criminal penalties and civil fines up tto$•100,000, in
addition to the cost of compensation!damages as provided forAn 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/
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
�he above-mentioned property for inspectio purposes -''f
V�
Signature (Owner/Agen ¢ p Date `3P 6
- _ ._.PERMIT# _ � - --. - CONTROL#- - -
• BUILDING PERMIT �lffly-> d7 4124
-6}
DATE 912- VALUATION [ 2,(14H?.(lU LOT TRACT
JOB E 514610 AVCNj I�F� .:��tAREZ
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
14 .r. 111:1 1; HOMES .
1.C:AdDEL VEN'rs,RES
3790 VIA Lj1__ LA VALLE SUffe 111
8361 "WC KERS 9r, SUE" E 30
I. bh IRA CA. W014
SAN D1900 CA 92111
753-11 m
(611-%4-1866 ClUx. 859
USE OF PERMIT
K) A ib/0K E'A
P001, 4 SPA (RO-Y
a+�,S't'e1��t�.'$' V.0 COM' i?r,i�' CONS�'jh:33f:"I'i��i'i
32,i1ii€6,i11i
1'1 H NiI T VY,E SI1801.AikV
Pf X.N f;,i•1't Mfr. PTH l (i1.-1)11{9-134 ,: 1 at $87,75
$1:35.00
17-1:13— 17001. Wt -WO -4213-000 �15,OG
111,30V3.fNf; MW f? 1,.' 1,01,000-41940 $s 7.fi0
r
I-18-`CCYVAL CON.'�.'FR 1G`'1'LO ._;SND PLAN CRUCK
$318:75
1. VSS:6?1 E4,1x;ID FUS
$0.00 ,
RECEIPTDATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD �. r
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
r
BUILDING APPROVALS MECHANICAL APPROVALS
Backs Underground Ducts
ms & Footings Ducts
b Grade Retum Air
el Combustion Air
Roof Deck Exhaust Fans
O.K to Wrap F.A.U.
Framing Compressor
Insulation Vents
Fireplace P.L. Grills
Fireplace T.O. Fars & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final POOLS - SPA
BLOCKWALL APPROVALS Steel
Set Backs Electric Bond v1 71
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
5dures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)