9810-176 (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. o '
License # I Lic. Class Exp. Date
q�:1o�i3 � allui�iv
Date , �`j`"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:
( ) 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).
( ) 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 Labortode, for the
performance of the work for which this permit is issued.
(Section 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.
STATEFUND 035-92-12:311
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant `
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject, an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions' and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each personat
whose request and for whose benefit work is performed under or pursuant'to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
&.hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation."
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property
'for
riinspection purposes.
Signature (Owner/Agent) —^� Date 1� '�'
i. •
BUILDING PERMIT PERMIT /t °°NTROL#
98.1 0-076
Ve
DATE VALUATION S24DJ72.20 LOT 52 TRACT 4'
JOB SITE- 7'r -x 85 TCi9C.1-li�,i A
ADDRESS
APN 70-466-00
OWNER*
CONTRACTOR / DESIGNER / ENGINEER
I..0
INC.
1425S UNIVERS111r D:FUVE
LA QWNTIk CA 9n53
PROENIX AL 851034
USE OF PERMIT
S.INGLI RluMIJ Y DWELLING
Sly, LOT ti 52, PLAN M PL'I�ttiiT D0133 -NOT 114CLUDE BLOCK WALL
OR ;I OOL, Pf•:RNIT FEM 1t1:.i3C7BY 7$% F0kNfU1 ,,['.fl'1X ISSUANl',F, OF .
SANS PLAN TYPE
..
ti
CUs 03M. CORiS'f RUI,"' 1010 -;2,470.00 SF
kORC'EilPATIO 1 L2.00 Sir
0ARAGPYC;AIi.P012.i 626.00 Sly
ESTIAIX I D COST € FCC!"NS's R UC7i ION ~
206.172.20
j?F""IT r, C, E SliJ.(9CKAR
VICYNISTRUC.B'LtJNFE.F 10.i.-()00-418-000 $i,e314. 9
Pf,AN CKCK FUT lO1- t9-31 i3 vit m.
&MR a; WWrr AL FEE i05,00
�:�c."IRICAL FEE 101-000-420.000 SIS6.4r
PLUXIBING I EEZ 101-000 419-000 �tgiU,5t3
S'i <?NOWYC1C!NFES -sa3�Sil) 10!4W, -74t-000 $+?nAll
c.: AUIraG rr;.t 101_009,_423-000 $111000
tlNPRA.STRUCl'i:+RG, FFls 225-000-443-342 54,60536
ART IN, PUBLIC K.AGhS - RFSI1;.701-M-256-000 S26S:4'?
• n
a
'. S3Z13-'ICYTA: , CK ANDPLAN CHECK
LESS PRE-I•'AID.FE S
KOO
OCT 141998 TOTAL�Velalrrf FEIRS D13F,INOW
4
S6,s76.26
RECEIPT
DATE 3
BY j
DATE FINALED
INSPECTOR
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 —
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 s
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
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
/sinal
Utility Notice (Perm)
a
F
_ nk
s CITY -Ur LH vuer:TA
__•_fir
OF BUILDING & SAFETY DEPARTMENT
777-7012
CTION REQUEST LINE
777-7153
OwjjCT I lk49%OMES.LLC
r t STMENTS
4810-076
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-485 TORONTA
SFD, PLAN 1R, LOT #52, PERMIT DOES NOT
INCLUDE BLOCK WALL OR POOL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK •-Z -�
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIG ED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
LJOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING —
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
< L FENCE & GATE
EWER SEPTIC TANK
FINALS
ELECTRICAL bit
PLUMBING
FINAL GAS TEST
!' ING - A/C l
` SE NUMBERS f
JOB COMPLETED '
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING