0206-072 (BLDG) (5)COX1,r ,.,,I hereby affirm,under penalty of perjury that I am licensed under provisions of
Hp Chapter 9'(commencing with Section 7000) of Division 3 of the Business and
Professionals Code,•and my Llcense Is in full force and effect.
*� Cr) Ucense i1 Uc: Class ' Exp. Date'?
/may 7313 3." .4 3131/01-
�ti � � , C t v ,• ,
. - w� �► y s k\ .fir• / /...^L���.�' �.....L�
d. Zr� ato ' "Signature di"Contractor—
tJ V'(0 OWNER BUILDER DECLARATION".
W W ~ I hereby affirm under penalty of perjury that I -am exempt from .the Contractor's
t co) - License Law for the, following reason:
Z '( ) I, as owne"rof the property, or my employees with wages* as their sole
7" compensation„ wih do the work, and the structure 1s not intended oroffered for
-sale (Sec. 7044',=Business & Professionals Code)..
t
( ) I,'asiowner, of. the property, am exclusivelycontracting with licensed '
f:;contractors to construct the project (Sec.. 7044,, Buslness :& Professionals
[ ' Code)"
I am exempt under Section t "B&P C for this reason
C 'Date ti�'c" yd .r.r.f'.;'A $Ignatureof„�Own6r `' .
WORKER'S COMPENSATION DECLARATION - `r
+�•I`hereby affirm under_;penalty of, perjury',one,,of,the following declarations:
OL
O3 l "have and will maintain. a certificate of consent to self -insure for workers'
X W ,LL t .compensation, -as' provided,for`by Sectionj3700 of the Labor Code, for the
`QA 'performance of the work for which this permit is Issued.
(� , s A() . I have and will maintain workers' compensation insurance, as required by
Q. J.* J,;�SMbn 3700 of the labor Code; fol the performance'of,the work for which this
(l c)'h-t permft;is Issued. Myworkere oompensation;llisurance carrier &policy no. are:
f Yob . 'Canter ` L OIOt� IN& t o. i` Policy No 9Vt:31Z08183
gr . (This section need not be completed, If the permit valuation Is for $100.00 or less).
certify that in the performance'of the work for which this permit is issued,
,,I' shall not employ any pers6n lh'any manner so as to' become subject to the
workers' compensation laws otCalifomia, and agree that if I -should become
subject to the workers'. compensation provisions of Section 3700 of the Labor
Code, I,shalhfprthw ith comply with thos t .
ate GGA Applicant
:Warning: Failure to securo 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
'sof the Labor Code, Interest and -Attorney's fees.
r' IMPORTANT. Application Is hereby made to the Director of Building and Safety
fora permit subject'to``the conditions and restrictions set forth on his
' 'aPPlication.
Each person upon whose behalf this application is made & eacFi person at
t 1 whose request and for whose; benefit work is performed under or pursuant to
' „Any permit Issued as a result'ofthis applicaton•agrees to, & shall, Indemnity
& hold harmless the ,Cityof La Quinta, its. officers, agents and employees.
.2f 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
r permit; orcessation of work for 180 days, Will subject permit to cancellation.
,� ,�h p- ♦ t
certify that 11haveread this application and. state that the above information is
• correct. 1,agreeao'compiy wlth all City, and State'laws relitIng to the building'
s s .construction; and hereby authorize representatives of this Cify to enter upon
-the above-mentloned property for Inspection, purposes.
ignature (Owner/Agent) - Date
s. BUILDING PERMIT,.-
DATE ! VALUATION •� Cyt � LOT
JOB SITE
ADDRESS , ^ '131. G— 3 TAN(i3.B"IIt WD s �`— r�
*+
APN . ,.
OWNER
CONTRACTOR / DESIGNER / EN &NEER
PGA VXWTVPF.i1i1 ISMAL HOWOWXM
WEWM )AM11-FPJ dLr 00RP -; `
R0, BOX 10607
sono SUM". PLACE 0a O�
LAQUINTA,i CA 51225.3
SAN D.U* =' CA X92122
(858)535.1475'SBL; 5023
USE OF PERMIT
C.3F.NII�AG BUTLnDNQ
SEISMIC -PIT; BLDG. 3: 34.5+83, 54.599, 34.593,
-RETRO
54-6011.14410,"544 13, 94-614, 54-625
VALUATION 04000.00 LIS
I�b'1TI"T” COST or CONI,it OC117or
PJt'RirJiCT.M SUiKIMAI Y
CONSTRUCTION FRE 101-000418-000 $439.50
STRO'NO MOTION FEZ - RUJI) 101-000-241-00(1 $6.00
r;
su mrii cox .rlcz oN Am -pr. m a
$40.50 .
M F%M-PAW F
�M 1b0.0(1
AUG 2- 12002
CiTY0fF1QUiNYA : v.
or.
FINANCE DEPT.
'
RECEIPT
DA E 4�I__
IN$PEC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
set Bacft
Ur4ergrourkl Ducts
Form&-FooWW
Ducts .
Slab Grads -
Return Air _
Steel
Combustion Air
Roof Dock
Exhaust Fans
OX to Wrap
FA.U.
Fmr*V
carve""
Insulation
Vents
Fireplace P.L
Grift
Fireplace T.O.
Fans 8 Controls
Party Wall Ina mon
_ Condensate Lines
Wap Firewall
Exterior Lath QQ
Drywall -Int. Lath
'
Final
FinalPOOLS-SPAS
BLOCKWALL APPROVALS
steel ,
Set Bacim
Electric Bond
FoWngs
Main Drain
Bond Bearm
Approval to Cover
EwOmnt Location
Underground Electric
Underground Pi . Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Wye Unes
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
Final
Utility Notrce (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
UrKlerRough ro ir4x Conduit
Rough Wir'
Low Voltage Wiring
Fatures
Main Sww*
Sub Panels
Exterior Receptacles
Smoke Detectors
Temp. Use of Power
Final
Utift Notice (Perm)
COMMENTS:
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