0101-012 (SFD)LICENSED. CONTRACTOR DECLARATION ; t`
I hereby affirm under penalty of perjury that l am licensed under provisions of
Chapter'91 (commencing withTSection 7000)' of Division 3 of -the Business and
Professionals Code, and my. License is in full force and effect.
License # Lic. Class Exp. Date
690CA 1.5 13 MC A
Date � `� Signature of Contractor t,t, u
;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).
( ) 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.
r'v ( ) 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 ` 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,prov.Piony
Date: G�, .. t 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 ih'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 io 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 forwhose 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. g
2. Any permit issued as a result of this application becomes null'and void'if
work i`s not commenced within 180 days from date ofrissuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that l 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. 14
Signature (Owner/Agent)
BUILDING PERMIT PERMIT#
DATE �� / VALUATION LOT ���D�.�T]^, TRACT
44 29447
JOB SITE
APN
ADDRESS�,�gry`n
i.7ef*'KA.767`d.'Y/1;.�:'Pffi�et LiF��
.. l /GV"fi�l!^iJb..^P
OWNER
CONTRACTOR/DESIGNER/EN (NEER
RXr HOWS LLC
X1"0.' ''I i"�11 ° , im.
PO DOX.. 810.
1425 F X)X.?VM9.rrY DRIVE
I.A, (`tTINTA CSA 9225:3
PHOENIX" A7 81034
(602)257.1656 4990
USE OF PERMIT
i
4'tba of'1. t3 .} a5 7.,Ct'Fa4A.1'P F'MI t' JIX n NOT INCLUDE
R3i�C' i'� .I�1JR7�SL�Tar`OidT�P,F P,r sib. a,F' f �, �1C'iH:]�VUILAN w3=R1��'G'w k!,, t�.EDUC"fVO
M1J'£.3'I1='IXII;JS'UANC OF'S-AMlzEa1 Al 't"1'i71.
CUSTOM CONN 'rUXTION zna.vp STS
t
E91,MAiiED COST OF 4:CD1dT�"�`.d��ET'Cn7(ON'
CQNST UC ION .FEE 101.000.•418=400 $1,1ov,s0
PLAN CHECK VFZ 101-0004.39-318 S226.50
1` rX,'HAN1'CAL 799 101.000.4 di -00 s $11 100
NRL1 CTR1.CALF914L 101w000-420-000 W8,22
PLUMBING MBING FILE 101 -000-41 R=0:00 5130.110
STRONG MOTION. PIVM • MID' 101-0010-241-000 $23.37
ILIPAI)TAO SRIF -i 101-000-423,000 00.423.000 Saw
DEV 1"1.: IP0.1 IMPI.ACT PEE $1,90.60
ART IN FUDIAC P1,YWO? - RE Sir 701-000..,255.000 3W
L .,C"C�iti7�fi 'E.)'CTTt'.W AND PLAX 01ECK,
$3,823,46
LF.S3 FRE-PATD YM
0.00
JOY
• �oo�&ALWEMAl.41XMES DUE -4 OW
4"h7g�9d3'e'7E8
HECEIF'T -
DATE.,:',,
BY�•�:�^r• ;.:�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksjQG'�
Underground Ducts
Forms & Footings
Slab Grade
Z . a ( h` v (
—� (
Ducts
Return Air
Steel
Combustion Air
Roof Deck l�._ �j ��
O.K. to Wrap l2 _ ��
Framing �.2 �_,� l�
Insulation yU�/7 ��
Fireplace P.L.
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
G ,
Final
Final
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
�a=G_� �j�
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
0. K. for Finish Plaster
Sewer Lateral
—� _
Pool Cover
Sewer Connection
U
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)