9510-042 (BLCK)I
Uj LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with
W Section 7000) of Division 3 of the Business and Professionals Code, and my
Cy License is In full force and effect. G9_cSgq 8 &1.5 o
r_ W License # Lic. Class , Exp. Date
n^ DatA-e`r`(� � . -, SignatureofContractor
Z �-'
(D � o) OWNER -BUILDER DECLARATION
J U' .I hereby affirm that I am exempt from the Contractor's License L w for the
I. d following reason:
U) ( ) I, as owner of the property, or my employees with wages as their sole
Z 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 Signature of Owner
N
rn WORKER'S COMPENSATION DECLARATION
a Q 1 hereby affirm under penalty of perjury one of the following declarations:
g Z () I have and will maintain a certificate of consent to self -insure for workers'
� cO compensation, as provided for by Section 3700 of the Labor Code, for the
X W LL, performance of the work for which this permit is issued.
p J J ( ) I have and will maintain workers' compensation insurance, as required by
CQ Q U Section 3700 of the Labor Code, for the performance of the work for which this
O U permit is issued. My workers' compensation insurance carrier & policy no. are:
d rn � Carrier aaj7r T iA^.'T+'.r) i Policy No. x;;;rfS gFfi%ilx
? Z (This section need not be completed if the permit valuation is for $100.00 or less).
00 Z)() I certify that in the performance of the work for which this permit is issued,
QO 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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
3 Date: Applicant
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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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
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/Ager> :) ,
ALC.
BUILDING
PERMIT
PERMIT9510-042
DATE 1i}/1Zf9
VALUATION , (}I},(}(�
LOT TRACT
JOB SITE ADDRESSAPN
7
i_695 DR', CREEK
OWNER
CONTRACTOR
�1�#!S f'�t t,l.i-Pt��NTEI7 COVE,
aR wTtem l r t k'1�.Ih.�I'rr�
fel 1 l,.J .t l MLa- I M�
7
St3 t�Ic �<rr +l 7' Y'A'P 1' i'T:'./�ll�' kIS PW
✓ l dVV atV,l. I N!. L i! i6 .,.. .I
/6_693 DRY L.BIEEK
LA U11,,4TA CA 92253
LA QlIIIN A. CA . 42253
(01.9).564-1.849 CBLY 3625
(619)56A-1849
DESIGNERIENGINEER
USE OF PERMIT' .''.NTE *}ch* i, FRALDMO
FEE DESCRIPTION
FEES
6 FT. WALL 100.40 LF
-
MIS ,141%1 s 1* COS OF CONS �..iw#� C1 0i�l
��J19t�.1J�
PERMIT I4%.SVIVI:N@ARY
CONSTRUC'110NIT 1U1 -t h}- lR-d(HE $54.00
/r
jD
OCT 12 799
,
gY
SUBS TaFAL CONSTRUCTION NID PL AN CHECK
LESS -Pr\ :-? Al FEES
150.00
T11Y..I.WL PERMIT FUS OV E;NOW'
554.00
TOTAL PROJECT PERD41T FEES
54.00
RECEIPT
DATE
BY
DATE RNALED
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
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)
a
� s
CITY OF LA QUINTA
LDING & SAFETY DEPARTMENT
V 4OFA� Jf
777-7012
OCT 12 1995 INSPECTION REQUEST LINE
777-7153
r-'NARMSMELLI CONSTRUCTION
Owner
SAME
Contractor 9510-042
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
78-095 IMMUEEK
JOB ADDRESS
100' OF 6' HIGH GARDEN BLOCK WALL
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL l
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
1
�._ ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/95 TURN ON UTILITIES OR OCCUPY BUILDING