0111-153 (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
60645 :8 TUC A 6/30/02
Da'te 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&RC. 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,jas required by
Section 3700 of the Labor Code, for the performance of the work for which this
'Apermit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier 51.AN 61M0 Policy No. I'MIS06-00
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I ce;ttify 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 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 160 days will subject permit to cancellation.
/ .01I certify that I have read this application and state that the above information is
correct. I agree to comply with' all City, andlState laws relating to the building
construction; and hereby, authorizelrepresentatives of this City to enter upon
the above-mentioned property for inspection purposes f� j
TQ
Signature (Owner/Agent) "'�-- - Da`te f• �r dew,
BUILDING PERMIT PERMIT# = `
DATE / VALUATION LOT. %-•iii TRACT,
JOB SITE
APN
ADDRESS 0-15511AAMNA
7724r
OWNER'`
CONTRACTOR/DESIGNER/EN 5NEER
PO B(PA,'RIO
? 425 :l?r. VNI)MR91f Y DRNE :
LA QIMT A CA 92233
PROEM 850.14
(602)257k,1656 C" Uf - 49.90
USE
yO'�Fy QP/E MRMIITry i} S � � p� F� { T yy i
A,tnd+�f�•f�Val9sL�', F'uf`1�*y1`dnY.Lf.i^. ,�kq,.•t�q�a J128YekkJ��n4
I .
tp' �p t�,2 p �••� tvr ��/rg�
y MCS
SAO - JJv 1 1 J, fa.ZAA.14 t".a'•t'i.ES.. 121E NU .i� 6.a� CS 140 .Ct C-I'4.�J.XV �.ta./i..+cK ^ '
WALIA K001, 800 OR 1)R.IVFW—&Y A,PPR.O.A.s°kf
'�`:"Ad�.cl CONSTRUCTION 3,14114.00 OF
t.
i?ORC 11PArIO - 77'3.130. ZF
£#Aki.ls.£St C.+` tPORT � t3.Ct0 Sk7
s
rKrIM'�.�4,.0 C0.2' 0F 4. �0i10FADhMMOK
199,734,90-,-
,99;%4.90• -CONSTRUCTION
CONSTRUCTIONFEE 101-000-1f,118-000
PI.A.14p C'�ill���"h• .4E -FJ 1 - O-41.9-3(711 8 022x.A 7
,
, X01yC7{
MJVCAII. RE
F'.tI .LTMI3IIM EEK 101 -000419-000 MOM
,
STRONG s5Jl.O�f40q FEE, RESIO 101.000-241-000
OP, Al' mo :fes.' ,• 3 'I...i
L' 7,V? =,':'P—FT$ 'AM P RC'T nZ-
NOV 21
2 0i
MOFLAQUII�FA I
S.N. = Ali"07CONST . ... _ �: i�i�M3� '
`
.224.31
IYOE NOW
4 34
y
RECEIPT
DATE
BY
DA,7I
SPECTOR
21
,. V 4r --
IR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
t6A
Ducts
Slab Grade
/Z _ p 3_ p Lti
Return Air
_
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
_ _
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Fireplace P.L.
Fireplace T.O.
_fir-vG�
Vents
I Grills
Fans & Controls
r
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_/I VFinal
Final —F �i�_
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
��Z�-� _ _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_ _
Pool Cover
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 ,
COMMENTS:
'
Smoke Detectors�y
Temp. Use of Power
Final
Utility Notice
p It
INSULATION CERTIFICATE
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California„in the building located at:
50-155 VIA ALDEA, LOT- 77, LA QUINTA, California
j.
CEILINGS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certainteed Thickness: R-21
GENE L C N iRA R:RJT MES LICENSE # 6
/ TITLEAA EL— lknb A
P r;N SCHMID BUILDING PRODUCTS, A MASCO COMPANY LICENSE #632072
TITLE: ADMINISTRATIVE ASSISTANT . DATE: 11/13/2003
�A