0006-149 (BLCK)I� LICENSED CONTRACTOR DECLARATION
".f bI,4;,phereby affirm under penalty of perjuryahat I am licensed under provisions of
F41, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
WProfessionals Code, and my, License is in full force and effect.
O =) �,� • License # Lic. Class Exp. Date - ,
W r 591 SlI'k�3 j° a:�/If^af
Z r- 1, /ate ' " Signature of Contractor-
Zo0�
CIDC:) « OWNER -BUILDER DECLARATION
LU W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
rn License Law for the following reason:
Z_ ( ) 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 fo'r''
sale (Sec. 7044, Business & Professionals Code). A
( ) I, as owner•of•the;property, amrexclusively contracting With licensed
contractors to construct the project,(Sec. 7044, Business &'' Professionals
,„ Code).
co- O l,am exempt under.Section , B&PC. for this reason
' O' N' Date + Signature of Owner
rn ,
Q • WORKER'S COMPENSATION DECLARATION,
)Q IM I hereby affirm under penalty -of perjury. one' of, the 'following :declarations
i Z. p O 1 have and will maintain.a certificate of consentto'self-insure for workers'
_ X. W L compensation, as provided for by. Section 3700 of the'Labor Code, fo'r the
mJ' Q performance of the work for which this permit is issued . � +
Q C) (i� 1 have.and will maintain Workers' compensation Insurance, as.required by
O: Q Section 3700 of'tFie Labor Code,` for',the performance of theiwock for which this
rn H permit is issuee"d. 'My workers' compensation insurance 'carrier &'.policy no are:
It z Carrier FRRMONT rwOW )NO Policy No. {- `SF59 1100141.7
+ r
i J (This section need not be completed if the permit valuation Is for $10o•00 or less)'.'
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] ct to the workers' compensation provisions.of Section 3700 of the Labor
C e{'I `shall forthwith comply with those provisions'.rtr/
ate: �/ (•( .t Applicant + ` ,
Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an; employer to criminal penalties. and civil fines 'uo'to:$100,000, in
addition to the cost of compensation damages asprovided for In Section 3706
of the Labor Code, interest and attorneys fees • '
IMPORTANT Application is hereby made to the Director of. Building and Safety
for a .permit subject to the' conditions and? restrictions -set forth 'on his
application. ,
1. Each person upon whose behalf this applicationis made &each person at
Whose. request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to',& shall, indemnify
& hold harmless the City of La Quinta, its off icers,'agents and employees.
—2: -Any permit issued as a result of'this application becomes null and void.if
work is not commenci d'within'180 days from date of issuance -of such
` permit,'or cessation of. work for 180 days WilFsubject permit to`cancellation:
I certify that I have read this application and state that the above information is
correct. l agree to comply with all City, and State laws relating to the building
construction, and'hereby authoriie representatives of this -City to enter upon
the above mentioned property for inspection purposes.
LSignature (Owner/Agent) ` '>' Date,dE'
BUILDING PERMIT : PERMIT# = '
0€19C► -I49
DATEr, VALUATION LOT TRACT
_ •- tj j ���' loElO 2$O 26152
.
JOB SITE
APN
ADDRESS 4-7-7W VM 1A. ®.h1.UNA
OWNER
CONTRACTOR /DESIGNER IEN 1NEER
CWADAY & C01ANZ
ClUpVAY & COgA"
1'570 BROMMU.:O-W DIZ1.VE,1 t ITE 209
1570 BROO_ HOLbOW DRIVE, SUITE 208
RANTA ANA CA 92705
SAi rAANA CA 92705
Q14)751-9151. G`P 4 4485
USE OF PERMIT
C}E�I.t"tili iiia E+-1.77.Ct.,7�i�•t1
103 LIP. @ O H101-4.11 Ur: @ 4' HICIH 0",DE.N WALT, o ORCO
t`.A3�'T:I.AIiO
61+"1+; �J�YAt.1, 103.Q0 L!' •
4 rt WALL 11.00 LF"
ESTH A7:M COST O:Ii+' C0NS'_rR TC':P1'OI+T
:1,7�3,i3tD:
PST Fn SUAGNARY
CONSt'Y UC11O11 M- 101 u000- 18.00 3 S54,04
}
Fn,
5
SUB-i'CVAL CONSTRUCTION AND PLAN Cl1;1...CX
TSS PRE -PAID FUIS
$0,00
TaTAL 1PERMIT ITT DUE NOW
RECEIPT
DATE ti �•BY
'� �,
D I
E
INSPECTOR -
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. 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
POOLS - SPAS
BLOCKWALL
APPROVALS' �
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
— p,01rD
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final"
_
Gas Piping
PLUMBING APPROVALS
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
Final
Utility Notice (Perm)