0002-383 (SFD)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 License is in full force and effect.
.Llo-rise # Lic. Class Exp., Date
Date -_ 1 -6 Signature of Contractor
,OWNER -BUILDER DECLAR TIO r
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 - i
contractors to 'construct the, project (Sec. 70441, Business & Professionals '
Code). `'- —- : .
( ) I am exempt under Section j' , B&P.C. for this reason
DateSignature' of Owner f- '
Y WORKER'S COMPENSATION DECLARATION'
I' hereby affirm under penalty of perjury one of the following declarations:
O I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 370.0;6f the Labor Code, for the
performance of the work for which this permit is issued. -
(1O 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:
Cartier Policy No. - -
;,�LIl.,.
. Jd�l 1':45. CQ.. �.... .. Z'J�•.aao•1�C•e_ _
,(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 manner so as to become subject to the
worked✓compensation laws of California, and agree that if I should become
subject to the workers" compensation provisions of Section 3700 of the Labor
C Vie, I shall forthwith comply with tRQse provisions.( /l
,.Gate �� k Applicant%
W � Warning: Failure 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 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.
/ignature (Owner/Agent) Y _� f f-'"� Date YZ!� 0o
PERMIT #
BUILDING PERMIT tw130_21 . '
DATE VALUATION $386469,'70 LOT.i� { 't.' TRACTJOB
Mtft
ADDRESS �! Cly !�pAiKC3tt"xt
APN
OWNER.
CONTRACTOR/DESIGNER/ENGINEER
t1.1'S;.'QNES :3� a�. ��:rtr j,.l.�. K
Fi+lf�( 3�r ry ri:1C it 4�.f ;21� (illi"OIeaPJiTiI~", fw
2100 E. Vv AS:t4Ltvt" MN �� �"�. €100
"Co,.rv7Cill3�J ,j. C":� 52025
ES{: (]i�f:� DD CA 9+2€)ti5
C -}31A 5413 '
USE OF PERMIT
. �.f.I�f4.r'�..�SftA�lli.r�%�V1l.l'..�r�.�l��i i•
aT�,l�- li. 7f 15 PLA.14 1-: « PEW- l"I .iJ30140T U14CN-.iiD1';; .es, .00C dCaA'LLS v
OR .POOL, 75`�,o FILAN t •tVCK k'EI�k 2ti;Dt.fCfI-0N t:OR MO `.i't LE 1.S6, UANCE : ,
OF SANIIE.lyLAN TYPE.
G"t�"� ± ���i . <.`•J i �'ZiZT 1i i'iC �i621-M &V
,POkCHP, ATIO S
GAi<.Fi0kE/t'AARf'a'3R1' 75$.(lt; V
4
- � n`T.h'U 1°r G:� 11 �;i+ i`15 .111.1C MGI
306;6609.'70
�~ FERMIT SUMMARY
-SI.644.00
CONaMtG1'1CON FEB 101-0t)t'i-41A-0(70 -
K. VNr'LTEM f 10t -W -430-M t32,5�
INIX11AJMIC'.AL KE i $124,00.
�.LTICTtiICA'L F 1.01 -000 -420 -OW $2,53.40
t,
�.
U! UMBLING FE 1:01-0130-419-000 S2 4 i 25
ti��cti•��: ^�f��.t��rl'.r.If� rs�;��,lt� 1911 40t) -24t.-000 � -- $•aR,E7
,,.� ,� , -
109 OfMv1
C}Rp73''fI;�C+y I��rL��y
•7" / •i
Q i {�2�0�.0?,
]�� (C�(LyGy-d2y3
D.1.`..t� 1>m 1 UCC A .J9�E k ..225-'000"44, -342 - Y13 fir I . Vf�
1
; N,
�'�* �"
AWI' L4l�Jl3" AC fr�,AC ES � 1<f Slt; 701-000-.2155-00C) $7 Ft+7►'7
a
10%M�V1YQTAL CMI'C UCTI ON ANDPIA—N rRECK.'
`G
- , LESS di4E-'PAID FEI di
X7?,00?
$.%2777
RECEIPT
DATE
BY
D�% INAL
1 PECTOR y
15 l..
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade 4W
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing uj
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_1? a _
BLOCKWALE A PROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam -
Approval to Cover
-
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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) AXIE
•;4
0J...
a
MAH 30 2004 14:18 PR INNOVATIVE COMM 760 839 8246 TO 7714156 P.05
Z0'3Jdd 9 .r., .-d. 0>r:frti T0, �Y ELS
t
CITY OF LA QUINTA
WILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REOUE:ST LINE
i 777-7153
Q fA
Owner C'APS'TONES C:OLF WEES"T LLC
Contractor , INNOVATIVF RESORT COMMVNffTE.S
Perrnli fVumLivY
POSE' ON JOB INCONSPICUOUS PLACE
In. PECTOR MUST SIGN a6t, APPLICABLE SPACES -
30 -6.45 WKI
PACE=S-
II.I S
JOS ADDRESS.
SPO -LOT 15 PLAN 3-2 PERMIT OOEl<:S NOT
INCIAME HLOCKWAI.I.8 011 POOL
/I'LAn� n
�m "w
ROUGH G" & GA8 TEST
FOUNDATION A SETBACK -
70011N0 STEEL
4kN GF:0UN0 SYSTEM
i
GROUND PLUMBING
PRE-GUNITE
_
DO NOTvOUR CONCRETE UNTI�,L-ABOVE MAS OWN SIONED
CONCRuE SLAB
JOISTS & GIRDERS
-�
ELECTRICAL GROUND WORK
00 P*tn C,MmtE YN
L ALL AROVIE S HABEEN SIGNED
_WCT
ROUGH ELECTAIC
ROUGH PLUMBING
ROUGH G" & GA8 TEST
HEA=TING 8 VENT. NC
ARFPLACE
ROOF .._
.
BOND BEAM
O.K. TO WRAP
FRAMING
INSULATION
PRE: -BOOP
Coven NO vioRk UNTIL ABOVE HALS BEEN SIC
DFOTVVALL IIViGRIOn
- ' r';
rVvCnin0 i AT'LI
I ,. ''. Y .T�
POOL FENCE &
�FI
ELECTRICAL T
Pl.ua+E11Nv _ _
FINIAL GAS TE$T
4671 -Nd AIC
HOUSE NUMBERS
A CCAAPLE F
I—
TEMP TEMP POWER
2'° VP/
ABOVE APPROVALS DO NOT INCLUDE RIGHT
. TURN ON UTILITIES OR OCCUPY BUILDING
dLT. z£O 'EO-£L-gapd
* * TOTAL PAGE. 0 5
s