0203-096 (BLCK)_ :ON
f hereby affirm under penalty of perjury that Iam licensed under provisions,of
Chapter -9 (commencing with Section 7000) of Division 3 of the Business_ nd
Professionals Code, and my License is in:full force and'effect.
License # Lic. Class xp. Date
Date •� `Signature of Contractor ' .�� ✓~
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that`] 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,f.Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date Signature of Owner
BUILDING PERMIT PERMIT#'�-
DATE _ f�LUATION�#50WOT TRACT. 216152
JOB SITE'
ADDRESS v 47-� '�'�:BE APN
�- N
OWNER CONTRACTOR / DESIGNER / EN (NEER
CANl+:4 AY & C>'+5Mr ANTY C"..t•1NADAY A C OIAPPNY�
174.80 L 17TH ST, 6106' 1,7480 & 17TI1 ST. 0106
TUMU" CA 92780 TUITrIN CA 92780
(.714)5084440 CBL44483
USE OF PERMIT
t;F.iu.rn` a�-.; iiia
WORKER'S COMPENSATION DECLARATION L—
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 Policy No.
6 MWAU 90.0 LF
4 FT, ii'r%AVL F
C3 STATE VU14 D )667391.0.1;. ,Y` LOSI".AR"IED COST CA'C;ONSTliUG` ION ��Pt<Sii�,Cld3
J (This section need not be completed if the permit valuation is for $100.00 or less). ��. T,-
() I certify that in the performance of the work for which this permit is issued, CrC�1�# '1'3'e1IC 3 C 1� P 1011000-418«000 ! S34.Dii
I shall not employ any person in any manner sd as to bicomeesubj4ct to the
workers' compensation laws of California, an�� a that f sbS ulld become � e,
subject to the workers' compensation %ov sidnsp? S t'6�0 of the Labor-
Code
abors-°
Code,-1 s Lfo t comply with those prods,
Date Applicants
Warning: Failure to secure Workers'C , pensation 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 ramages as provided for in Sect i6n'3706
rn'� !
of the Labor Code, interest and attoey's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety p;°•y
J 4•»..
for a• permit subject to the conditions and restrictions,, set forth on 'his
application. r ,
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 a8TM-- C.-01! &T�t1S€"�7CIMT ANN) FLM MWE `3' 4.00
& hold harmless the City of La Quinta, its officers, agents and employees. -. IJ743 gM�i"sut'AW 1'.i E3 Moo
2. Any permit issued as a result of this application becomes null "and void if
Qr
work is not commenced within 180 days from date of issuance of such 'r xC?`b'.6 L �"EMWI+�+ P1'S DUE NOW .00
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and sta��thsaf the above information is Yr
• correct. I agree to comply with all City, a d St,��tela �s/slating to the building
construction, and hereby authorize rep► en ti es of this .;City �to,enter• upon
the above-mentioned property fo'r•i spec 10 purposes. `
�• / / �rr' jJ
j RECEIPT' DATE % DAT FI LED INSPECTOR
Signature (Owner/Agent)f�. 3 �rr'%i ;" i�r r. �_.-� �0 3
Date
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
/ a7
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
< d
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Mmbing 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 Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
j ,5/07%01- MOiIN 16: 22 FAA
1
�� No. 31653
*. Exp. ,y31/2004
OUi
/ f
Coll e'/yLrD O�
I I
LOT X148
N 8217J'i1' W �� u, I .
BLOCK WALL
40 L 0.2 EO CONCR447E
65' ORI WwA Y
PLAN 10-
L/V1NG AREA = 2.427.0 S.F. II
GA RACE AREA = 426.0 S. F. 2i
w FF: 61.40
PAD: 60.90 I
LOT 1149 y
2' EV
WALL .1C
I
• I i
I
O LA Q INTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE '�_ BY
1910 S. ARCHIBALD AVE., STE. N
WEVELOPMENT ONTARIO. CA 91761
909 930-1466
4/ES/GN FAX (909) 930-1468
CORPORA 770N PANNING • CIVIL • SURVEYING
DATE:AL EET: JOB N0. OF WATER LOTS
05/07/0SH
1 1 '=20' 1 J065 LOT 149
:OT j150
Mm4- SCALE 1 "=20'
47-185 KA AN779ES
LAKE LA OU/NTA: 1A oimIrA re ogia: