9905-249 (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 RIISiness and
Professionals Code, and my License is in full force and effect.
License # Lia Class Exp. Date
637252 I3 02/10/201
�Pgt_e 19 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). ^
O I am exempt under Section B&P.C. for this reason
- Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under pehalty of perjury one of the following declarations:
( ) I have and will maintain a 6ertificate of consent to self -insure for workers'
compensation, as provided for'by Section 3700 of the Labor Code, for the
perfo mance of the work for which this permit is issued. .
114) 1 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.
ROYAL INS. CO. Or, 1 ITC 45028
(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 thosQp�' visi ns. '
Date: q_1 Applicant rP
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' r
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
�forainspection purposes.'
Signature (Owner/Agent) i Date
1 1,
'BUILDING PERMIT PERMIT9"�249
DATE//',, VALUAI ION iii e€ 9.8fli LU I I
'� 1 HAC
lU'
1013 SITE
ADDRESS ' 41-75 SUMAC STREET
APN - } al,� d➢
OWNER \
CONTRACTOR / DESIGNER / ENGINEER
CA'i'f�;LLUS RESIDE{+MIAL CONIM..T.NITIES,
TNI,' CATEI. LUS RESIDENTLA,I., CONS'I'.RLJCTICN
5 PAP.K PLA2:A., surns 4OO
5 PARI. PLAZA, SUITE 400
IRVINE CA 92,614 '
MVINE CA 92614:
(949)251.61.00 C8L# 4072
USE OF PERMIT
SINGLE Ft1IMIL Y DWELL NG
w -PLAN 2/i►12. LOT 26 -4��13�t��!° f ld)� .5 i�iti 1 NCl,UDE kiZ.tjCK t'VAl..LS
OR POOL, PLAN Cf*,CK 1" to TtON OF -FEE F2RI)UCED_ FOR MU'L` 1PLF,
I&SU.r1NCS OF SAW -'PLAN TYPE
3t. •0.:01. N 1a..� 14.130 SF
L�L• 3 CION 7:t itWti.r
'
PORCH.I"ATIO 120.40 SF
GA} AMICf1RK-)RX 483.00 SI:
P.iL.RWI i FERISUMMARY
CO S`MfJC':CI:C?N F EE 101.OW-418-000 �65:G.(lt3
11j..A+`1, CHECK HE 101-0W-439 -318 $14530
NIECEiANICA1. M 101 -WO -421.-= $66,50
E-LEi TRICAL EE6 .101-000-420-01iO
i,lf�dk�.rlVefl k�f? 1CJl lUO X31 1-000 S154.00
STRONG itiL4Xf10-`f; FEM - RX -8 -fir) 101 -000a241 -OW 511,50
ORAOI;J'r•I"C"1.•: ` 10.1-000-423-000 520.00
lbrJ .MTk7qCMR9 F Q 225-000-443-342: S 5S I.33
ART_EN'PFJBVIC1'i.ACISS,.,t R.143 -SW $37.4$
n.
i
6(.r. -n?rfAL CONS'MC1Gi1ONAND :PLAN CHECK
$3,803.36
LESS I�,I�F,.PAID FES
$0.00
TOTAL P001 FEEN 1)I.f K NOW'
JUN -0
RECEIPT / /�
D T ^ 1? y
.B4Y.i j t� .;
JIp
DATE FINALED
INSPECTOR
f.� 4 l ,l'
-1
¢I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
Slab Grade
/
E (J
Underground Ducts
Ducts
Return Air
Steel
Combustion Air
Roof Deck
_ E Q7
Exhaust Fans
O.K. to Wrap
_
o- 2 - t
F.A.U.
Framing
.fid �'P
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
BLOCKWALL APPROVALS
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
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
— Z(D- 00 Pf 14
Appliances
Final
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 4. 70 0
Utility Notice (Perm) _. Z _ -t � ®Q
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