0007-235 (PAT)�••, LICENSED CONTRACTOR DECLARATION.
I i;reby 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
6 407,/ �, .✓ 07/3112(
Date)?�`'} Signature of Contr ctor
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 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 STATE MD - i` Policy No. 046=6007332' -
(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 Californ �nd agree that if I should become
'subject to the w /`kers' compensation`provisions of Section 37.0 of the Labor
Code; •I -s Il .fo with comply withtthos provisions. �.. �'�
Date: f � 0 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, Vd-State laws relating to the building
construction, and'h re eby authorize repFeseniatives of this City to enter An
Pe above -me Honed prooppe'r rty for inspection Purpose
Signature (Own gent`) �r� Date
V ;s
r -
BUILDING PERMIT PERMIT#
DATE VALUATION LOT,�"� TRACT
'
JOB SITE �q�+
ADDRESS i"2s a7vlod.�.4a,`�.9�'y�ur
APN
_ y
OWNER
CONTRACTOR/DESIGNER/EN INEER
LA Q'i.aWA ORC HARD PAt2`1' PM.1;
SPA,2 W Ci3MRiJ+�"t: ON
RO, BOX 31716
79^295 RANCHO LA QMW.ADR
i.AQUDTrA CGA 92253
LA, Q1 DTPA CA 92253
(760)771-1941 if2996
USE OF PERMIT
pAn0
TWO COVERED PATIOS (618 S.F. &414S.11.) TO— ALINCi 1,067.
S,h PERAPPROVED PLANS.
PORCH)PATIO 11062.00 SIP
ASS +!1;A = COST OF C O IS'Pi i:UCIVlUM
14,1244
PERMU. FEE MARY
PLAN CIMC K PIE 101-000-439«318 5105.30
CONSTRUCTION FEE 101-000-418-000' 4162,00
�
ELECTRICAL PER 101.000«420«000 $22,50
PLUM13TNO IPFI1. 101 «000.119-00
STRONG MOTION M - REBID 101.000«241.060 MAI
JUL 2 8 2000
K.f3-mTfi,.1:,, COMOMION AND FLAW MEM
LEE* M -PAW MM
ZOO
'4MM, IIMMff M. IN DM VOW
4
RECEIPT
DATE
BY
P.
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
2 0O
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
Combustion Air
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
A 6j
Drywall - Int. Lath
.f
Final
Final
POOLS - SPAS
BLOCKWALL
AP ROVALS
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
Encapsulation
Gas Piping
`
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit •
Rough Wiring�p—
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)