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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
'CY;Rpter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is. in full force and effect.
License # Lic. Class / tExo. Bate
/ 34M7;1 C3iS 0
YDat e f� `/��l Signature of Contractor
OWNER -BUILDER DECLAR
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).
( ) I am exempt under Section B&P.C. for this reason
Date f h op 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.
(y) 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.
WIII FGN111
(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 any4manner so as toibecorAe subject to the
workers" compensation laws of California, and agree thaf if }I should become
subjeci to the workers' compensationrproVisions/of,4Sectfon 3700 of the. Labor
Code, la shall forthwith comply-with-those,provis S
7 r" t
Date: �,74 Awl Applicant / f`t�L.^.,......•—
Warning: Failure to secure Workers' Co pensation coverage is unlawful and
shall subject an employer to criminal pe alties 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 I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws telating to the building
construction, and hereby authorize representatives/of this City to enter upon
/the above-mentioned property for n-Sp/eE on /p�uurpd'o/s�es.� (/j_ S✓/
ignature (Owner/Agent)'``tl�
1
BUILDING PERMIT PERMIT#
9"1111-152
DATE �j�y VALUATION LOT TRACT
$2-19AW.00
21' "t
/_ i .
JOB
APN
�E
ADDRESS
ADDRESS S4,510; TY�`,NZ.(SE4e 1��1�.
774-271-00 6
OWNER
CONTRACTOR DESIGNER ENGINEER
Sr6VEIt & vAIt M (RIK
�KE ALST4 {VrEPUPPUSIES
5=3510 AVL•;►'�I'IDA D A:Z,
39463 V1A'fi"EMPR.ANO
LA (J1.1.G:NTA CA 9225A
M?J12. IETA. CA. 9"563
(909)677-5129 CI'Ftfi:4 5513
USE OF PERMIT
1149TA1.%. '1.l m.-. oor,-mvuNTU) 8.OLAR,. 7AW-19 FOR OOL akr[N.G. ,
A.i.i:.,-KQtjF - M�)(3N1'ED.E.QIJ,.If:IM,6N'r Sf.IAl..1.136 SCK1i afdgC) F'itc m, R()tfN..
n
VlKW.PAin
JAN 2 9 1999
VA p
ESTRiiIVIAT 1) MSU 011? MA &VAA".
ITUM T F E Si1MM:f4:1RS`
00N31RLJC I' ON FEE 101.0{N)-418-000 $54:0
11JAR»161140 Ham, 101-000-49-010
5IA_^r YrAI CONSTRUCTION TION AND RAN CHECK
LESS PRE,. AID FEES
$0.00
`9'41'i't.11, PERMIT ?NS 3bVE NOW
�'7�.t1i➢
Ilk -ill .
RECEIPT
DATE
BY ( ] t>
DATE FINALED
INSPECTOR
�.0
INSPECTION RECORD
y 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
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)
MIKE WALSH ENTERPRISES
Solar Services
39834 Old Carriage Road - Murrieta, CA 92563 • (649) (909) 677-5129
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BY
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14-h51711f� 1975 -.1995 -, 20 Years. of Service to the Solar Energy Industry