9910-185 (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 3of the'Business and
NroteS§1011915 lade, aria fitly LidenSe is. in Lull torce and effect.
License # Lic. Class Exp. Date
6971. 17 B
Dat ! Signature of Cor tracfor,�r'!���
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
compehsation, 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.
R) 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:
STATE i� �3� Tr`tg�(1ui1�r12D
(This section need not be completedifthe 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 anyperson in any manner so as to become subject-to.the
Workers' compensation laws of California, and agree that if 1 should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Dl�: u/if.i� 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 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.
y ,
Si nature (Owner/Agent), v 5g re 'Date a
PERMIT#
BUILDING PERMIT:;
-[OJOB
.
DATE q f� VALUATION 31J;JA5, 6.44.) LOT 57 TRACT 2150.1
SITE DRESS 6.l1l4,8r! rL�IVII�C�
APN F2Ei�-,71Yiyr�
WNER
CONTRACTOR / DESIGNER /ENGINEER
OLIPHANT,AND, MI ,i°lAMS,.ASSOC., MC.
011r.F✓iP(b1fliMf'XND 1Vi L'1.A,1kXS
7.-900 .AV1;lv0: OF-Va.,. `s"rA I'
PALM W9k,Sg;F f° PA 9221.1
:PALM Da" `i ft`E' CA 92211
(760).M5462 OBLO 5203
USE OF PERMIT
{{• `57 } y t�►�
yr.D-,:HJT 57, %?.LA%, `3k PURI+ri T Wf KO!r' :W'•4U=—' 1 L0CK Wk\LL< C k,
K(X.
PORC'IN"ATIO 120ko Sft,
%;;ARAf3:EIl';AJ t110RE r 6.►Y):ti0 5F
. Es R B..Nv A .E!i.OJ '!,.m or :4.,'\6rwrll®u en.WF f
PCt:RMIT F .1;E SITMNAR Y
CONSTRUCTION PEE 101-000-4I"00 $'l'fi5.0i1
`P71,,AN- 1 Cyy! 4
Ed�Cva.`K F F, _6
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tV.lirl�lrid'LS!4.941'aL � a a 1.t1A.-tl.IV"�B Cr �'"VtPL,� .G'iri1..7.V
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:...y t ! t SI_.
DZV1M,C)PEk.'a4TJA(�T1 FEE
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' 47t.PS:YI,NDA,e'bJ,. l.,:'1�NSR°iG. X01.fLtl.ly AND P -1 -AN C.lf"4.i:! Yn.
LESS. F R -L i 111? FEES
$0.09
RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
A fA
Ducts,
Slab Grade
I
Return Air
Steel
Combustion Air
Roof Deck_
/
Exhaust Fans
O. K. to Wrap
Framing
F.A.U.
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
BLOCKWALL APPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
Gas Piping _
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
1"!. Z . qq A14
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
,
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
2 —5"-00
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_'fig -
Appliances
Final
Final
Utility Notice (Gas)t�
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 ba
Final
Utility Notice (Perm)
COMMENTS:
m;
.Cerfifficate -of Insulation
Yow Hani,e bas been insulated with UminTeed F%mglm Insdatiam pudacts, which are detigned
m
today'sY staadasds tamor7aw' a
Fibettlass is in"pnic•and therefima permmwx* e, so it does not have to be treeled
o
with &tedaat cheoucals that will ItkpJy lost their� aver time It bas net been trealnd
!_1
with, chemicals ihait can cmiode wiring or metal. Tftoam will ant ahsbib moimim nor will it
sectile over time as may other insulation matmala
z
c
'Phis also cemdes than CwtsiaTeed Fiber Glees Insnlatien bas been picfessiawlly installed in this home
D
to gravida the LNlowiitgthetmul -.
doh Name: Sons® Tract= 25953 Plan N. 3 Fhase: 3
Z
Let No.; S7 lob Address: 794" Calle nowise, LS Qni� CA
D
in .
_.
:D
Csillag Area: R-39 UnfiLmd Garage Crating:
With i ivbg Abs e -
Interior Wade:
T Exftrior Waft R-13 Unfumd
w
Party Walls: With I3vrgg Above
Ln
{3 layers) CeiBmg Balidras:
m
Subcan&aC&r OjIAw ation.Co.; lmW_'
600 Asaw 6 937M ORQMU• W70 lftmma" 7o9
Signed
Concbila Omar. Secretaryffreasuret -,or— R SCO& Jenkins, PresideW—or-
- Lou X&&10, Directot ofOperdalons Offl%er
R --means resists m . to heat flow: The higher the R- vWur,, the Smater the insulating power_
Ask your badder for the W sheet an R. valttes. Keep this owificate with your oftr
o
valued papom If you ever sell this hone; this entilicate should" be passed ' an to the buyaL
ry
..
ao
C9
CITY OF LA QUINTA
°� BUILDING & SAFETY DEPARTMENT
s (760) 777-7012
- INSPECTION REQUEST UNE
`�►OF (760) 777-7153
Owner DAVID TETTING
Contractor OWNER BUILDER
Permit Number COURTESY JOB CARD
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79444 CALLE SONRISA
APPROXIMATELY 52 L.F. 3 COURSE (3011)
COURTYARD WALL AT FRONT OF RESIDENCE,
U/G ELECTRICAL
FOOTINGS / STEE
w Fvv I ruUK WNCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
MAWNRY INSPECTIO
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
PRE -PLASTER (/
DECK BONDING
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL /JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING