0308-239 (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
7281.07 1 R_ Iffe, 13
90104
Date 1,111?• 12 �) 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&P.C. for this reason
Date Signature of .Owner
WORKER'S COMPENSATION DECLARATION
1� 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.
(n ). 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 ou) it1? U,9141C'am Policy No. NWC10434541017
(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 thoseprovisions.
Date:" -/,y ..1r) ,. Applicant d �{ ✓i /lf
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.
%MPORTANT 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, and State laws relating to the building
construction, acid hereby authorize representatives of this City to enter upon
the above-mentioned propertrty�fr inspection purposes.
'Signature (Owner/Agent) i`�/=`c"rte Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT -2.39 TRACT
$1??,0.2.90 15 30521.1
JOB SITE
ADDRESS 44-ftS W'AALONVIRA
APN
604402-009
OWNER
CONTRACTOR/DESIGNER/EN (NEER
T.C`.AYN•,h H0WES OF CAJ IMitt+ 1A
LENHAR HC11 OF CAWK)RNIA
718-4.01 C: T, -J AY 111
18.401 C HIGHWAY I l 1
LA Q11WIVA CA 132253
L& QUDIITA CA. 92253
(760)7 -Wool CF3I.O 3434
USE OF PERMIT
5110 M LOT 15, 7x.L A.`Id 4YBK PFAMI 1' DOES NOT INCLiiM BLOCK
WALi.» P0014 +SPA OR„D1ZIVYe.TWA.l''APPROACH
TLACT t• NSTRUCTION 3`1040.00 Sq
F'GR.C,WPATIO _ M.00 Sir
C1A.I2A10VCARPORT 42SA0 SY
.ED 0091 O �'CaN91"�+ 0C°. ON
11771052.X:
�y'(,•y'yyp/�ry q; � /� p9 �,,yR�•�p yESMIQA
d".fC�.1CLNl,L.tt./!JIS..C7e l7YJilI.66Y/Y.d,9.i.C7.
CONSTRUCTION FFS 101.000.418^000 S3+7:n
PLAN C°f-i.C'C'NI. T:,F 101-000-439-319 049.16
WCHANiCAL FEB 101.000.421.000 966,30
ELECT TRICAL h'LE 101-000-420-000 5,148.40
>'1.i3MB.T14CI FZE 101-000.419.000 51%.00
STR.OND MOTION 1 '' RES10 101-000-24,1-000 $$171'76
ORADINt3► FZLf 101.000.423.000 1115106
!3?'tr3'.1..OPER I1 PAACT 3rl:i:. ,40R.00t
ffUB-1OT'AL COMIRT3° KION AWD k A1% CiRQX
$4,486.26
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$0,00
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DSC 15 2003
CITU OF LA DEPT. / /
FINANCE DEPT:
RECEIPT
DATE
BYD
T -FI L
INS CTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs !
Underground Ducts
Forms & Footings A Q_
Ducts
Slab Grade
Return Air
_ _
Steel
Combustion Air
Roof Deck.�_ _
aunt 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
ol
Final
Final
POOLS - SPAS
BLOCKWALL A PROX&L
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROV LS/_
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
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
4" 121
Final
Utility Notice (Perm)