0006-150 (BLCK)• 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
WProfes.,�onals Code, and my License is in full force and effect.
License# Lic. Class Exp,
Date-
591f5G1 )a wr_.�� t33l.1/�L
t -Date f � Signature of Contractor "5
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). •
O 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 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.
'( )r 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:
CarrierI�R1;idit' N T (.OMPj 48 Policy No. :: OF50-1100-14170 .
(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 mariner 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 shallforthwith comply with those provisions'."
Coate: �.?1 ,, N 4Applicant _: - .. ✓a
Warning: Failure to secure Workers'•Compensati ' coverage is unlawful avid
tc.
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 isohereby made to theSDirectorof Building and Safety
for a permit subject to ti', 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, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes: ,
•.Signature (Owner/Agent)Date
BUILDING PERMIT PERMIT"
(}008-9,.50
DATE • VALUATION 7S.00LOT TRACT 261-52
281
JOB SITE
ADDRESS 4%_75 VfiiMOiV ANA.
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CANADAY & COMPANY
CAcC NADAY .C01VANY '
.1570 BROo2L1L:i ti W DME, ffUITE 2018
157 0 DR00101OLLOW DRIVX HUM 208
SAKI TA AWA CA 92705
SANTA ANA CA 92705
714}751-913? CB141 4485
'
USE OF PERMIT
93 LA. @ 6' HH 313, CiAR1D N WALL < ORCO STATMANA
6 F74 WALL . 8109 L
CONSTRUCTION ME VI1.00
.. ♦
Yr,. �� �wr t
M-TB-:TO'TAL CONST- U' 'C,"lION AIgD )?L,AIT CIT&CiC
$54.00
L.MS PRE -PAID nW
$0.00
RECEIPT
DATE
BYi
T .117aE
INSPECTOR
V INSPECTION RECORD
SOPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fprms & Footings
Ducts
Siab 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 6 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
Final
BLOCKWALL APPROVALS
Set Backs _
Footings iZ
Bond Beam . ev
Final —Gtr
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top Out
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
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)
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
COMMENTS:
POOLS - SPAS