9711-057 (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
Professionals Code, and my'Lcense is in full force and effect.
License # t - i ic. Class 'Exp. Date
47966-9 ..13
/bate �7 Signature of Contractor' •�>
17
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 con sent 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.
.Jwr)''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:
CALCON IP W977I61261
(This section need not be completed if the permit valuation. is for. $100.00;or.le'ss).
(') 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 •1 should become
subject to the workers' compensation provisions' of Section 3700 of.the Labor'"I;
Code, I shall forthwith comply with those provisions.
Date: /::- i ,_ TMs Applicant—1 'oe
Warning: Failure to secure Workers' Compensation coverage is,unlawful and
shall subject an employer to crimihal penalties and civil fines up to $.100,00.0"in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees 4 I
IMPORTANT Applicatioriis hereby made to the Director -of Building. and Safety
for a permi t. subject to ,the conditions and "resirictions 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 applicator.agrees to, &'shall, indemnify
&ahold harmless the- City of La.Quinta, its officers, agents and employees.
21.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 cancellationt•,m•a
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
theialove-mentioned property for inspection purposes.
!�Date—.
Signature (Owner/Agent)A�fi* V141
c PERMIT #TROL#
BUILDING PERMIT `w
CON//q
DATE VALUATION LOT 9711-057, TRACT
111181." 54,,402.00
JOB SITE
ADDRESS
APN
47-735'VIA i1I0NTANA
OWNER 1 e '.r - �;
CONTRACTOR / DESIGNER / ENGINEER
LANi_l._AU Dt V CCS INC :.
IMPERIAL SUN CONSTRUCTION :
P.0"H-01 472
YR2 71�;iic C.i1"i`/C�1fiJYt)G�'iiJi
PALM SPRINGS CA 9.2263
PAL41 SPICINGS Com' 92203•
iafl�32f3-227 / COU 3'79- .
USE OF PERMIT
;.t .I . 7. Cr
r
.144 LIN FT OF 6 fil IbARYais-N WAI i. AND 47 LIN FT 4FT 6 N GARfA314
`+VAL1.
146.00 LF
4'F°1. WALL l
CSTt1,%1LkfED CONT OF CONS' *1JCT10-NI
PERMIT FEE 31tM'tb1zNR*°
c+aNSTRUCTION FFFE 101-000-418-,000
a �.. -.
`-
t-, . `i�.ti3 0.F" L CONST!?U>r'i`IGRAIND, PLAN t���l:iICK
��.tJt�
00
,mak .. LESSi%}ti -}AID f`irhS
"Y
ToTAI." PERMIT FEES DUE NOW.
$72.00
RECEIPT 6J
DATE
BY
lei
DATE FINALED
INSPECTOR
0
-0-
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
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
POOLS - SPAS
BLOCKWALL APPROVALS
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
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
COMME S: n
G ��
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)