9612-024 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury tliat Cam licensed under provisions of
CliapV-e9 (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
f1
Date�'f ' ' `1/�! 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:
( ) 1, 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 declarations1
() 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 Policy No.
STATE FLIND 071095V4
(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 prp�visio� s of Sectio 3700 of the Labor
Code,/F�I�.shall forthwith comply with those provisions �'
Dater `'`3 �� Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000,1in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth ori his
application.
1, Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void'if
work is not commenced within 180 days from date of issuance of .such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize �r - res@ntat�ves of this City to enter.upon•
the above-mentioned property for I spection purposes.
Signature (Owner/Agent) V� Date
BUILDING PERMIT PERM T# °°NTRO #
4 419
DATE VALUATION. "� i;3.'S.'�9$L.�1� LOT TRACT
ADDRESS. 7 �'�.� �.'f�]{lD�aDr JOB SITE
APN
OWNER
CONTRACTOR
.i,-�.r. � ..��.r1,:,i't. f•. ,�i.:.l+[,:I:.±.i i�i4 i.ila f•�F..1' ..
�/DESIGNER
�/«ENGINEER
rt
491'.�c'1f:�..l.4r c...(�1'i�3i�i�i.l.l1.'�AION'' -
1',0. W.W.1'716
79293RANCHO LA OU1v`i.tl M
.(..AI -Ari -NIA CX 92253
GA Qt.1INTA- CA 92253
USE OF PERMIT
• �tt�lt�'l�.ib .i�A��li.1" 1'��Vi?i,l.i:ly<
llyciAbj I lilfi+ttld k
144iRM1'S',11"Eus.4014.1: . I' AN ,ih.`.i' 1141aiJPL1C-.P Ak7V9 CTUEDIT OF
S21.4.95 MR ALGRGMt?tv'I'Wl'..n I O'OMtMUNt`CY DRY 9- i aPM�'
C S'!01Mi:i'ifY.31`Rl'dt`:`lION 2,23I -W AT.
1'+UIj.L' EY NATIO 170.00 'it"
i3AJLACi1Jt:A1*;IAtJIt'1' Q'1`+h.4U :y.'f•
U11STMUIT M'CiJ'riit& OP Cv1.y..'F .tiUC.TI'l N -
I�v,.�,.Jc81 �4f
1'i .RMIT F EV, SUMMARY
PLAN CHFCK O1!1
CC)''NS'iFCiIC110.1q 1,714 101 -OM -418-000 19,if2.i
NTECHAZACAL FrXi 10I. -O) 421-M $98.50
t:i,£:CTIUCAL F.E i. • F0.!-006420.000 $161.81
el<UtvlNma FkT-" 101-000-4104)00 3142.00
- �1'O+�O:MC)'T'ION �:-'iL.Fi1?� iAl•T)GJ-?�!-(�(.tf) �I�,SE;
GRAM 10 FEL 101-,OW4253-000 320,Gu
114F .JVYf.ttlJt i"CEltE IEg I. 225-0W443-_» i4,124.71
Al2:f XPi KJRS IC PL,A:(;8 3 - PWSTC 70.1-000-255--000 5213.95
flfi':1' 1a'T'1;11�T.Tt"l�L,At;CS •x;21; Yf)1 O(}�-254 {?QO 4233,55
1
SUP -TOTAL CONIS "1'UC."1IC.)P1ANT. PhA.N C-14ficK
$6,_500,37
1„ ES$ PRE -PAID FTS
-=3.95, .
TOTAL PERMIT FEES IDUE, NOW
Sfi,241i.de$
RECEIPT
DATE
B`%
DA FIN Eq
INSPEC F1
/1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs -
Underground Ducts
Forms & Footings 42 X
Ducts
Slab Grade
Return Air
Steel
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 l
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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fudures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS::°
�G 7" G 4L
_ s CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
w 777-7012
INSPECTION REQUEST LINE
777-7153
CITY OF LA OUINTA
Owner T.D. DEVELOPMENT
Contractor sP A RICS C.OriSTRITClnRl&N1 O 1996,
Permit Number 9612-024
POST ON JOB IN CONSPIPW
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-848 VIA CARMEL
PLAN 1 TERRAZA
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING -war
PRE-GUNITE
DO NOT POUR CONCRETE UNi1L ALL ABbVEAq4ASBEEN SI NED
CONCRETE SLAB L /
JOISTS & GIRDERS
ELECTRICAL GROUND WORK/.
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST l
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING 1
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN'SIGNE
DRYWALL INTERIOR -
EXTERIOR LATH
POOL PRE PLASTER
POOI_FENCE & GATE
SEWER SEPTIC TANK ,7- Z v
J�
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
��„� TURN ON UTILITIES OR OCCUPY BUILDING