9903-166 (PAT)LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
Cfi5ptdr 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
Li6ense'#' Lic.'Class Exp. Date
3/310
VDatp Sigha.ture of Contractor At
OWN ER-BUILDER,.,DEC LARATION
I hereby affirm under penalty of perjury thkat,.l am exempt from the Contractor's
License Law for.the following reason:
-)-,.,.Ij.as.owner of t ' he 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).
1, as" owner of the, property, am exclusively contracting with licensed
Contractors to construct the project (Sec. 7044, BusineSs & Professionals
Code). 1. . .1
O I -am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I herebyaffirmunder. penalty of perjury.one of the following declarations:
I have and will -maintain a certificate of c ' onsent 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
Sdction 370 - O.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.
UNKATMIN,5CO SIM -1193-14179,
(This section need not be completed if the permit valuation is for $100.00 or1eii).
O 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
sub eworkers' compensation provisions of Section 3700 of the Labor
Code,.!, h comply With, h
e.. Applicant
Warriing: Failure to secure Workers' Compensation coverage is'unlawful and
shallsubject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section3706
pf�,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 p6rson.at
Whose request and for whose benefit work is performed under or pursuant to
any, permit issuedas 'a result of this applicaton agrees to, & shall, indemnify
A. hold harmless the City of La Quinta, its officers, agents and employees.
,1 A - ny per mit 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 at5rove- mentioned property for -inspection purposes.
vS/ignature (Owneir/Ageint) Date V -f
PERMIT#
BUILDING PERMIT 9903,166
DATE VALUATION $4,469.M) LOT TRACT
r5 I I&?
JOB SIT9
ADDRESS 47-580WAIKONTAINA, APN
OWNER CONTRACTOR I DESIGNER ENGINEER
CMADAY & COMPANNY CANADAN & QONTPANY
1570 BROOKHOLLOW DRIVE, SM7208 15770 BROOKHOLLOW DRIVE, SUrM 208
SAN117A ANA CA 92705 SAKCA ANA CA 92705
(7t4)751-9151 C131A 14485
USE OF PERMIT
. P.A110
336 S. r. EENGNE MkWOPAT K) COVER
PORCHH11W 10
336.00 SF
MgMiT FCC) SUMMARY
PLAN CHECK. frEf.- 101-000-43.9-318 $46,80
C0N3TR,UC1 !ON FUE 10 140-41 MINI 1572.."
STRONG N40TION PTE - R0,11D 101 000-241-000 $.So
S S
UB-TOTIAL CONSTRUCTION AND PLAN CETCK
LESS PRE -PAW FLES
TWAL- 11MMIET PfIES DUCTNOW
RECEIPT DATE it, � D
", �i�l , _,,r�, I BY 1yqFIN - 6� , JINSPECTOR'
DU I - / /Zl or I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
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
Finalul
POOLS -SPAS
BLOCKWALL AP ROVALS
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
Neater 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
UU14 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)