0005-231 (PAT)F6—
(V co
W
O
' LLJ
rZ CE
Z
OI�
CD 0
P 6
~Waw
U)
Z
LICENSED CONTRACTOR DECLARATION
,I hereby affirm under penalty of perjury that I am licensed under provisions of
° Chapter 9 (t 2mmencing with Section 7000) of Division 3 of the Business and .
Professionals Code, and my License is in full force and effect.
Ljcense # Lic. Class Exp. Date
Signature of Contractor.
OWNER -BUILDER DECLARATION
k I Iereby affirm under penalty of perjury that I am exempt from the Contractor's
_J, �Jdy\ense Law, for the following reason:
YI, 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
(Sec. 7044, Business & Professionals Code).
�• I, as owner of the property, am exclusively contracting with licensed
con ractors to construct the project (Sec. 7044, Business & Professionals
a7,exempt under Section B&P:Cafor this reason
1lt 6_ ! n
ate ") 1 1�°,� '. ,-> �- Signature of Owner i . �rv� � '�•A,Yj"
r -
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.
( ) 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.
(This, section need not be completed if the permit valuation is for $100.00 or less).
X I certify that in the performance of the work for which this permit'is issued,
I sh'all 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 provisions of Section 3700 of the Labor
" Code, I shall forthwith comply with.those provisions.
Date: I , , 1;-O Applicant
1
Warning: Failure to secure Workers' Compensation coverage is unlawful and
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 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 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 1 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.
Vignature (Owner/Agent) i{zI (I —� �- -L�. Date i
'�"�' BUILDING PERMIT PERMIT#
DATE VALUATION LOT W,15 '231 TRACT
JOB SITE
APN
ADDRESS 45.040 I) MIIIE' .DRTIVE
OWNER
CONTRACTOR/DESIGNER/ENGINEER
FRM J V&AVIM
OWNERTL L—DER
45-04.0 DLM.T3M DRIVE
4 5 -W. D:1IBBIE DRIVE
LA Qi17i TA CA 922-53
LA Q:U&J'A CA 9223
(760)772-62,06 <,mft
USE OF PERMIT
'PA710
PATIO COV FI21 +100 SQ 17.
PORCH/PATIO 400.00 V
FSlIHrla).T C=OS! tai+ C0N1' RUG''n,01\`1
S,.'i2oxg
Pl1'➢7:Mff GENE' 90AUAA Y
PLA14 CHECK FLIT: 101-000-439-318 $5210
CONSTRUCTION FETE: 101-000-118-000 1.00
S`I'RO'NO MOT'IO'N FEE - RESID 101 000 $153
KTA-TOTAL CfJNMUf" 1014 ARD PLAN (919 ?C K
$134. 1 S
TYYrALL, PE736 r",Y';S 11ME Mow
RECEIPT
DATE
I B
DATE FINALED
INSPECTOR
1��5r''ECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
• BUILDING
APPROVALS
MECHANICAL APPROVALS
Sq,Backs
Underground Ducts
Forms & Footings
S- eQ>
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
q;1.v-1 Q•�
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
B LOCIrKWALL
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 Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pale
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)