0105-073 (SFD)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 ,06p. Date
Date Signature of
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Lic?nse 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).
O 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.
�( )° 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 n, t '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 ree that if I should become
subject to the workers' compen satiomprovi " ns of Section 3.7.00-ofthe Labor
Code, I shall forthwith comply 11th,,t��, 00S �ovisio .--'
Date: Applic t b _S!
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 faes'
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 represe atives of this City to enter upon
the above-mentioned proper for inspection purpoo
es,
Si nature^(Owne; % en I' °� " ' t—Datet'0` •
BUILDING PERMIT` PERMIT#
DATEVALUATION LOT ' ��170� TRACT
-g.37 �.Cf3 421 `� 29147.2
JOB SITE
APN
ADDRESS
7-575 o5EWV0Lt? DP )
OWNER
CONTRACTOR/DESIGNER/ENGINEER
F P.00X DEVFW.PNWf CONVAITT
ASHBROOK DE.V010P U �:-XWVANY
S 140 A'd MJU).f9 aTC1NN3
5140N& I. A1390100
C,r`aRL SBAD CA 92008
(:k RLSB t D CIA 92008
(760)$04-6868 CRL4 3376
USE OF PERMIT
SwaLE
SF0 - LOT 43 PLAN 30 - PERMIT DOW NI rT 1RC:iwi: M,13t.00KWALL,
POOL (3ft D1UVEWAY,Afr':P6iCJ.4 CH. 750A PLAA CfIECK r+EZ.d1PPLIED FOR
Mibl.411 PI,1w ISSUANCK, or Shme PIAA TYPE,
PORCHIPAT10 SP
QARAINMATfNOM lun
'.daO COTa"r OF CON11710RU017011
236,37160-
36,37 60-
�IG71MA
CONSTRUCTION
COA?STRUCTION FEE 101-000-4118-M S1,1.19AP
PLA14'CHECK 1YEE 101-000.439-3I$
MECHANICAL FM 101.000.421,,irW $85.50
�"I,WTRIC."AL Tt'1E 101-000-4$0- COD $161.26
M13Fa3'PTHO TEF 101.000.419-000 510.50
ST"FtONO MOTION .f t - Rgo= 101-000441.-000. '� !
ORADWO 110,lo�� 9°�soc� c1,ea
01VF,1DFXR )1ld1'.€aC T YZE 07.00
ART DI 1aUDLIC PLAC,98- I1EPAE` 701 -0W -255-0W $00.99
r1iRL3:l�' T, L"CJN t CTION, AND PLW MIErx
LMS PRE -PAM MS
$0.00-
t
JUN — 5 2001 9�'PIES VETE y �
CITY OF LA QUINA
FINANCE DEPT
$3,814,557
RECEIPT
DA`E�i;.
BY
DTE INA ��
INSPEC
f:P
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings _ n
-' —
Ducts
Slab Grade +�!//��,(��� (�
/�7- n� a
Return Air
Steel
Roof Deck
_ !!" _
/��
Combustion Air
Exhaust Fans
O.K. to Wrap
-�� _
�l Z�!
F.A.U.
Framing
-�Z- pl
Compressor
Insulation
� (,y
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
71
lI -Int. Lath
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
Waste Lines
0.1
�p�Qt�`
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
��� ��
Pool Cover
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)
�/6K j