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9706-001 (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 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 reason: l .( ) 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 () I am e e pt under Section B&P.C_ for this reason .a /7 n Date /4 Signature of Owner IT 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: Carver Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). 01 1 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 su ject to the workers' compensation provisions of Section 3700 of the Labor de, I shall forthwith comply with those provisionss� 1 ate: �/� �: Applicant ��i,„es.r.,fjr k, Warning: rFailure to secure World r ' 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 correci. I agree to comply with all City, and State laws relating to the building corsttruction, and hereby authorize representatives of this City to enter•upon t above-mentioned property for inspection purposes. f N Signature (Owner/Agent) �+' �Al Date,Z PERMIT# CONTROL!/.: BUILDING PERMIT , DATE VALUATION LOT TRACTJOB SITE ADDRESS 54-015 AVDA MARCY. 1NI APN 7' 4_i9_J 1,6 OWNER CONTRACTOR/ DESIGNER/ ENGINEER , 5•iw75 t14' NIDA 3tla EZ t.A {?tANTA. CA 92251 CY3U, USE OF PERMIT 37 -I.Y., 5` (3a WAN WALL, INGIN17110U.30 DOWN. 4 hl,l CTR ICAI, iJBVICIi& , 5'FT. VYAI.L 37M) LF 47.0143TRIUC 'M d tits' lot -000-41.9 ?340 $21001R " ht r'±'. !C: rR tf!YtiC1(±L1 A2 �t�c1� SUM) • e C" � GrJ l °•ti 4t { SUB -TMA -1, COMMUC.' ON AIND PLAN CHECK $38 M LESS ,SRC-I't1,lMPEES $0.00 ., $39.00 ' RECEIPT DATE B,Y DATE FINALED, INSPECTOR . f. 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 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings g 7 Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Under§round 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 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 000 -.Cal n "s &. w " f'y 7"42 i5reeS Ife- 5isAr+y ovu- -Au r "1,1 1f 7' 13 0 MOT -7-,�Ie/l-/nirf C e�,irzoola 14,e i4ve c 5 A,/Ckpl) �, / l -/� 4 �o /5ox/le/sx.�� (41)4il✓e�4 �r� J/b SE/s�9/G �I�l<S �Srls�L �'lC<�er v7/e 6 7 x o• s .9 532.7- r9 /6 ,6f' �iO-e , ') WV/ I e" -s ri i = Gilesied,;- t 740 Zo i r Det , /i►',1 �- Z8, ice'% � 6410 23-� 74-�b/e- 2 3 -171 'op I74e 30�, ��e S1r„�iTol/c- S = /,q �f/e�-.� ae /ra c.-� li H e s sen i� ,*P= O, 7X A8x/3e/,0 = .7 2O /b1,o,4. -sf 1-/ &.,m- /p 16l 2!3r -r- 1,61 3 -r - ,67) w � 3 Seisr�,� �•e,�,s w 5 I CITY OF LA QUINTA SUB -LIST CONTRACTOR ADDRESSS4-76,:�i-Ob�7,2-v-z_ -OWNER— .L5ppp rooJOB ADDRESS This form shall be costed on the iob with the Building Insnection Card at all times in a conspicuous place. It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub -contractors that are on this list are the same persons performing the work. Any changes to this list must be approved the City of La Quinta Department of Building & SafetyUtLor to work being performed by a changed sub- contractor. Failure to comply will result in a stoppage of work and/or the voidance of building permit. ................. .... ............ .... X X ........... X ...... :x ................ ..... ... ` ............. * ............ ............... ............ .................. x.x ........... .... .... ...................... . .... . . .. .. ..... ... . ...... ... ........ ........ ........ .. ....... . ....... .. ..... ..... . ....... .............. ........... ....... X X -X ...................... ....... . ..... c . ........ ............ ...... .................................. ............. . . . . . . .. . . . . TYPE:::.GF:.: .... ......... ...... . . . . . ... .......... I ...... ... iw. :-..AT. .............. . `ST. ..... .. ....... ........ ............ .................. , ............ .............. . .... ............... K .................. . :: B . .......................... .................................... . TRADE . ................... ...................... ........................................ .... .......... ................ ...................... ....... ...... ...................... 9 ....................................... ..... .............................. ....... .......................... ....... .................. . . ... .. ........... ...... :.11C .... I ..................... ............. ...... ... WS: ..... i�.WNTRAQT--,.* . ......... :: ........... I ............ ..................................... - . OMP'.1;,:: NA ............. PC ...... ..... .............. . .. ...... .. SIB ....... . ..... .......... ............ .......................... .. . .... . . .... : 1*1 *11, .... ............. ............ . .......... ................................. ............. ........ ....... ...... . ...... ... .......;:::;:°:....... ................ . ................................ ....... ........ 1:::::::......::-:-X-:::: ......... ........ .................... . . .... ................................................... :.:.: ... : ............. : ................ ...... ............... ..:>:<::::N.. ...................... . ....... ....... SE:U ... .. MBER M E WEIL." . . ....... ................... ......................... . .......... JU.MKR'K:` .......... . .......... .... . ....... ... .. .................... ........... .............................................. .......................A&,,V ... ..... :::: .................. : :... - - ..... ... ............................ ...... ............... . . ........................... ....... .. ... ....... ............... ...................... . ......... M. ............... ............. ........... .............. .... ...... ...... . ...... . . . . .......... A .CAPVW T. .................. ....... ............ ............. ............ GRADE*/: ....... .......... ................... .............. ..... A/C -12 .I. ............... .............. EXCAVATE .. ........................ ...................... ............... ....................... ............... ... . .. . ......... .... . .............. .............................................. .............................................. C -34 .... . ....... .......... .... ............ .............. .............. .............. ............................................... .............................................. ... C-8 .... . . ..... 0 ............... FOUND A;? ................... ...................... . . ................................ ............ ........... X " ' ' ' ' ' .'.'.'.'.'.'.'.'..'.� . . .. .......... .. ......................... A .............................................. ........... ..................... ................ ::.FRAMIN.: ,...,...,_, ... . ... ... . . .. ......................................... B .............. C-51 .......... .................. .......... .................................... -1 ........ .................................. ........... ..................................... .................................. ............ . .. .. ........................ i� MqScopw C-29 0 0 6 6 (r, VC '3 V7 ?- 3c q ...................... ........................ ........ ................................................................ ..:.:..:.............. %....:..:............................ IN.. C -6PV. ............. .: P. . ING . . ............. ..................... .................... ...................... :1 -ATH . ........ .............................................. ........................................... .......... .. ....................... .......... ......................... .. C-26 ........... ............................... ............ % ........... ....................... .......... I ................................... ............................................... .............................................. .............................................. ........... .................. .D. ................... C-9 ............................................ .....M ............. ........................... . ........................................... .............................................. ....................... .......... - ........... .. ..... . . ..... C-36 .......... ............................... .............................................. .......... ... .............. .... . ....................... .............................................. ............................................... .............................................. ............................................... . ..___ ....... - C -20 I .... M ................. ........................ .............................................. ............................................... ................................. ............ ............................................... .............................................. ............. .............. .............. .'ELEC...T-.-R'l.C--'AL-'-",:.'..*..'..'..'..'..'.'.'.'."'.' .......... ......... ....................... .......... M .................................... C-10 ........... 6h., ra j ............. ...... .......................................... ................................ ..... .. ........ ............................................... .............................................. R00*0. ........... ................... .... ................. C-39 -.......................... ................... .1 ............................................. ..................................... .SH -M * L::::'::' EET" f -T' -A1::::::*.*.-. C-43 .. .......................................... ...... I ....................................... .............................................. .............................................. FLOORIN. .... ...... .................. .... ........ ................ ........ ... .... C -15 .... . ............................... .................................. .... - 1 7 ............................................ ............................. ING ..... .. . ........ ..........»>'>>< .......G..........L.......A................S ......................................................................................................................................... INSULATION C-2 SEWAGEDISK . ....................... .............................................. .............................................. ...................................... C-42 . ............................................... ..................... ....TINGZ ............. ... . ...... ............. PAI ................. .............................................. ........... I ................................. C-33 ............................................... ............ �`.D EC`RATIN ......... ......................... .............. .............. ............ ........... ... ............. ............... ..... . ............... - ............. ..... C-54 . ..... .. ...... .. ....... ....... .... .............. ........... C-6 NSTALLATI......... .. ............ ' ............. .. ............ .......... .. .. . ...... . ...... .. X, ....... ......... ... C-1 3 ................... . .. ... . ... ... .. ..UA N .M:...... C-27 ............ ..... 0 .. . .... . . .... C -53 .. . ... . ..... - ..... ........... 7y- 141ca/ 6ee7ll� Eket4,16mr.>er -pe 2e 4.1 AX 7ia 0 -N" " I 06 --AWS 'o�S/ yoeea, o0ps 5ho wgl CITY OF LA Lit-1'-ij k BUILDING & SAFETY -DEPART�iEb-1v CONDITIONALLY ACCEPTED FOR CONSTRUCTION SUBJECT TO INSTALLATION AS PER AND ALL APPLICABLE CODES