9905-252 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter f -(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
02/20/204
ate '9 Signature of. Contractor
d
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.
L I have and will maintain workers' compensation insurance, as required by
Se fon 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 INIS. C0.0I+ e pTC 4.592r,
(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 thos ovislons.
,/gate: 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 att°
whose request and for whose benefit work is performed under or pursuant toy
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.
gnature (Owner/Agent) Date
L9
BUILDING PERMIT PERMITN
DATEVALUATION %%08F2481" LOT 9 -. -- TRACT 29601-1 =—
6- 2.99,
JOB ADDRESS 47'x#5 :�Jui1�UC &*T Rf,, h T
APN 649-030-020
OWNER -
CONTRACTOR/DESIGNER/ENGINEER
C..A"tEf,. IS RESIDs4 ;Ir1TI CC) 1''1M1r11ES,
.CNC CAJ7,LWS RESIDENTIAf, COMM IX -711.00'N
5 I11i. . P.i.F't? k SWE 400
5 PARK PLAZA, SUI L 400
IRVINE CA 9261.4
I:kV:ENE CA 92614
f94`)121�fj1()f) CLQ"
USE OF PERMIT
STi3OLE FANUL DWS UNG
STD - PLAN I -Bit, isfa:lT 2� —PERMIT .DUDES NOT INCLWL UOCK WALLS
0R POCX..PL.AN ( ECK .iaOH TION OF FMR 1)U 754'® F01t i1+9'L3f..'I°IPL
13SLIANCT1 OF SAMf:::'PLAN'l PS
TRA(7r CONSTRUCTION T',€2d.Tl";TION $,803.00 Sf'
PORCIRi:Pivrio 1.28.00 SF
0ARoW fC71+►JR KJkr 441,00 3
�L>¢� TI XEM CONT Off. sC.'ONS"�'�MIC ION"
.110,2. 9.9'Q
COfd.`1'IV,UC`.CION FEE 101 W-418-000 $671.00
FLAN CHP.'C F5F ltll auk -4z?_ fR a0.stt
111 L iTi ;1Ci L F�_4 ;ill-t�t30 *?,1 0f?0 56650
UIxc :f'ii:[e AS FEEL- Sa2OAa
tzLi:abfF YN(3 P`t !03 iiliti-41 �-(3f10 S14100
liX
STO ONO NIC 1 ONA FER -,R U 10 b t Nl(), ,11-(?(iP PDX
C7IOD13, 0— F i{i—R?{k.ri:w-i1(1s3 $20.00
UXVRfl8TKtX I'AP1 3 FTF; 22:5-000-443-3112 X2:,3 7.30
i1 RTI :PUBIAC::;PLACXS - REM, $20.62
i.
c -If Ufns., CCsMTl i lif:iN1 AN1) Pr,AN Ci�E K
��„5 :17
LESS FIRE -YAM BITS
�
$0,00
.p 81999
T3TAIr PERMIT WVS DUENOW
&$N54I9,17 .
'RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
fN
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
/
L� G tf
Underground Ducts -
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
�_a _ 4'q
Exhaust Fans
O.K to Wrap
d --Q i
F.A.U.
Framing
—.- T•
Compressor
Insulation
y,- f S r
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-
Drywall - Int. Lath
/- -
1
Final
Final °S_ °Da vily
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
b/n Q
�fO�j
Heater Final
Water Piping
b- zi
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
p sr
Encapsulation
Gas Piping
Gas Test
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
Utility Notice (Perm) 7 -7.-
COMMENTS: