0209-089 (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
:533r;,11 Bt9.{c 03o/02
Date ` �� 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). 1,
() 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 FUND Policy No. 071$2
(This section need not be completed if the permit valuation is for $100.00 or less).
( (.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.
bate: `f . ✓ %� , A licant """ _ - 7 71
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 pursuantto"
any permit issued as a result of this applicator 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 'succi:'
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.
Signature. (Owner/Agee- a'r'k Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT' TRACT
t� { ." C.* �, ,.. av�,"sdl 14 X41. 5^2,
JOB SITE
ADDRESS 50-320 VAIJ,�lrM Co. F
APN .
773-022-021
021
OWNER
CONTRACTOR/DESIGNER/EN (NEER
SM)0,14A14G?It ES, WCC
CORI-10,12:�i:i' O
'77-564 CiaU'.ia:CRY GIMP, DST: SUITR 137
77.643,A.Ct3M'RY CLUB .DR7VEWITEV 150
CIA 92211
k-Albul�lf..�'�1c7." CA 92260
060)7'72.82;4 r-93.,9 1;137
USE OF PERMIT
MCHL2 ;FaAIvMY DWU JING
,
SVD » LOT 14 PLAN 3A .,I•'IQ,;1;MI I° DOES NOT Ith CLLI'M f; LOCK .
WALLS, POO4 SPA OR DRIVEWA`i'.A#'PJ3.O:t CH, IMIN R9DUMOAI TO PL4.VN
C HMC K FEE' TO F1+IL.tIMPLE ISSUANCE OF SAUZ 1111Wd 'TYPZ
CUSTOM Ci7NMUCr'TION 2;-MtW SP
T'C. RC:WPATIO 216.000 S`IP
0ARACIMARPORT 11=8..100 8k
ESTE!"M C o r, ale C:`ON'.1�1'J'an{7m
.VX.)<`.'L V! "AV
C(MST UC'T1014 FEE, 101-000-418-000 00.418.000 s1,Fi8 00
PLA14 CT M% FEE $214.69
MSCI A-HIC:ALi EE 101-000-421-000 3102.1"
E b'.C'MICIAL FEE 111 -100.420 -WO $139.80
PLUMST90 FEE 1041.000,419d000 S-1:,25
Si'lt6NlCd' Iy arION Fi:,wu.' REBID 101-00N,241:,000 $22.65
-
GRADWO RE 101 000-4223-000 WIN
i9W1 LOP(: R IMPA.C:'T IF EE
:FART -M PUBLIC PLACE1- ReSIE Z -000.445-000 San
- -
ai 4f.Ka'+I'!+ rAl,*n bl� f.,��A'...i4VCMO At4.y4�'.Pf"��y,�cb °e��
t.T.
SEP . Z 11(102
OF LAAaultaA
PINANCEDEP'T
DATE ;, BY '',
DATEFINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
,d
Ducts )_
Slab Grade
Return Air /
Steel
—p Z
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 —
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
_
Waste Lines
- J
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
Final �f
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures 7Z `J 7—
Main
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final --/jW—
Utility Notice (Perm) —
COMMENTS: