9812-129 (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 Exp. Date
>" 6_0064_5 t3 c 6;30/00
/ate-1�� Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
() 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 Policy No.
FCi'v;'' ups-���.1�3i►
(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 agree that if I should become
subject to the workers' compensation provlslo of Section 3700 of the Labor
Code, I shat forthwith comply with those p -2io 1Date:" �� ' Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and.
shall subject an employer to criminal penalties and.civil fines up to $100,Ooo,�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 personFat,-„
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 .
t permit, or cessation of work for 180 days will subject permit to cancellations
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 i specti n purposes.
%, /Signature (Owner/Agent) Date/'�✓
BUILDING PERMIT., PERM' 98122
DATE 12 VALUATION $206,1 721() LOT) TRACT 2V97
JOB SITt
ADDRESS ld.Yi6ilV.A�.
APN 7�1-BSaC 9➢1V
OWNER
CONTRACTOR/DESIGNER/ENGINEER
_ P.,1'tT NO NME, e..1.e_o
P013ox.91.0
1425 E. UNIVERS11T DR[V')
L.A. (,)UINTA CA. 92233
PHOE,mix AZ 85034
1
(602)757.1656 AFRI# 49.90
USE OF PERMIT
SINGLE FAM3t,."`a.' DVE1.,LNO.
L d a7 PLAN 1.AR_ S -17W:! MIT OOES Ib"s"'T iNi""1,U1 .8 F'kLWK WALLIS
OR POOL. PLAN C'ktFr...,1;'. Fid l7:i XK,'.E-V two FOR'MULT 1'l. ISSUAI1CIE'� OF a
SAME PLAN TYPF,
%iiWOM CON'STRUMON 2,4 70.00 S
t
PORGFtVA1'16 112,00 1f'
�
GARAOFJClAR1'O.K'r _ 625.60 5F•
ENT.IleA`d'S:E V CUST € FCONI STRU1:'i"11MN
06,17.2.20
CON'S' IZVCP10N F96 101-i}t➢f1-4115=000 `,1,614-tt0
1 t_" CHECK k- 101 -NO -4-19,3113 S203I,f.�
1161 3AI CAL FIS 10.1-000-421-00Q �tOs.ttO
a[:C`1•'R1C&{ 'Ffffi 101-000-420-M 5.156.4;
PL1JNLBt JQ4 FEE 101-(M-419-000 $180.50
STR0NIGNOTION F M ! PX, 3310 .10! -WO -2.41-600 $2a). IQ
G#.tk1 ING M. 10.1.-000-423-000 $20.W
lNfttA-.37 UCT M 225 -ON -441-342 g4,os.36
-
ANT IN PUBLIC iC P1. AC"ES - .RESIT: `7t11 -QOU 255 000 �lia5 i:3
A
Rt M__ 1' AL CONSTRUCT A:.1110 pr,A,N CHEC►s
J,-*, - �' LLLSs1. f"iVi-.S".tiID FEES
.. . K iiD` ,
.
p E C.'2 " 199E 'COTtet VOOM.' ��.EMS �,�.f>G NDW
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RECEIPT
DATE'BY'" ; t
DATE FINALED
INSPECTOR
V 1 .r
3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
14
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
C'
Exhaust Fans
O.K. to Wrap
_ �G'
F.A.U.
Framing
- — l`C
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
z 2
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
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
6t
Encapsulation
Gas Piping
Gas Test
2_0
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) C G
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 C
Utility Notice (Perm)