9606-146 (RR)_ . LICENSED CONTRACTOR DECLARATION:„ r -
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 91(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
Signature of Contractor, �V �
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
r 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
perfor ance of the work for which this permit is issued.
( I have and will maintain workers' compensation insurance, as required by
S f tion 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. +� ,7f� - ?60
�� '�. f t��� 17 `/ /
(This section need not be completed if the permit a uaion 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
S,pbject to the workers' compensation provisions of Section -3700 of the Labor
Code I shall forthwith comply with th s provisions.
Datej >/ y ! .Applicant '� `�'._ ��,�`' !•. --
. r .—
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 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
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;
,Signature (Owner/Agent) - Al Date n`_ _` ILI
°°NTR°`#
BUILDING PERMIT . PERM%06446
DATE 612.5,N6 ' VALUATION f3.000MO LOT JaQ TAA7Q-A .3586
JOB SITE
ADDRESS 4W E VELASCO
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
JEAN I� 0WE
SUNRISE '100FIN000.
12389 L R<.'XsL ....
5&Zi2 C ARLSBU c'r.. .
SE NA CA 9W2
'YUCCA VALLEY C:A� 02284
1
2L.4Yi`.T�.i. Sr�A .
USE OF PERMIT
�al�Nt�l�t..at1.(. �31JIl...I�.I�Ii,t
111:4100r, REN10V 1"s ROCK iZ13MAC H WITH COMP, S fiNCl`MV , 3.P',
s'\x7tLV\.7R' �.UU ,l
F:.' TIXtATED CQST,0F C-T)INSTR C',t•tON
31000.00
, l��it�Jt7i� N'�T i.0"i:�I!{it? 41fI-t?ttQ �3tf.Uti'
SfJ 3i 3,'11i. t?`NS'TRUC:".10N NINE �':i.1�N t��I.ECK
$30.0q)
t. 'SS 'PRE' -MID FEES
${i.ili3
6,1996..'
JUN ,2.
RECEIPT .
DATEBY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION DATE j INSPECTOR
BUILDING APPROVALS.
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
w
Grills
Fans & Controls
Condensate Lines
Final I I
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Plumbing Top Out
Equipment Location
Shower Pans
Underground Electric
Sewer Lateral
Underground Plba. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
- COMMENTS:
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
Smoke Detectors
Temp. Use of Power
Notice