0108-291 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapte• 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 /' 1 Exp. Date
863 1£I7 P I' Si3110a
Date �'' �'' j Signature of Contract"r • t-•
OWNER -BUILDER DE.CLA
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 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.
�) 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.
Z'ENf if M31 CO. 7.04239130115
(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
workers' compensation laws of Califor ia, and agree*at1jif I should become
subject to the workers' compen sat iorovisions of Section 3700 of the Labor
Code, I shall forthwith comply with those pr visions.
Date_ 32— Applicant -7
Warning: Failure to secure Workers' Compensation overage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compenpation, 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, andjState laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection
�{Vpurposes.
Signature-(Owner/Agentl`%- y�--- } i! Date. J% Cif
M
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 108-2,03 TRACT
50 47
JOB SITE
ADDRESS �.�n•� y,py� cfi /�� -
FOCI^ l i3Cr �A�.L�.As*b���
try [9l
�`i.�A'�C 71PCfr1.'Q`
OWNER \
CONTRACTOR / DESIGNER / EN (NEER
INNCYwnVE M, x)xrCC3mmuNrd n, .1kiC.
200 K WA M—MO'I:ON AVE, 9''17, 100
200 L4. W114Y y'TYA7td AVE fill 00
CA 92025
IMC"CSkkiDU-10 CA -2025
(760)839•fnn C:O ✓11.14
USE OF PERMIT
SFD • PL.A34 I>'P,A,, WT 47. PIP.Fi'.MIT DOMS 1407 ML"f..l. OP, 00,0US'PA,
1414="W.d4YAS OR F.JYiWFfWAi' APPR Pr.Ct•1
e
CUSTOM CONURVcf°r1atl ;X570100 5F
B6.2 9 2001
PORCHIPATIO 594.00 SF
t'1A,KA01J? %RP0P.T W7.00 OF C
TY OF LA QUINTA
FINANCE DEPT.
:K8T'JCt %TXD'.0 ydrOF C0119:6RI5'C:"110-K
3W156i.50 ..
PgMiT M Sub "WRY
t,"O1'dVf1.IXTION ME 101 wi300pA x �UOU 31, 4 ,'
PA.,FsN CHECK kvx 59
MiMIC'rAL FEE $118.00
la.�t.,.C>T RIGA L ".iP, $191,.91
FLf,TMDING F£tE 301-000.419-000 $219.58
STRaNff MOTION ntf - RMSID 10') -.000-243 -OW v30.00
GRADING FF,9 101 rarl" O.423.000 SX6+0
l)LT'i%E 0PIP514. IMPACT FEZ $119M.00
XYD-TOTIAL C09 .111 ITICIfICK AND PLA14 CHECK
S4,34.4.46
MI.) FRE -PAID FRE1
$0,00
':I YW,5'3.4RliY TFIRE i9-'liXM .Ct#OW
$4,344AC%
RECEIPT
DATE
r ��
BY
DATE/FJNALED
-0-0
INSPECTOR
j
// Z
INSPECTION RECORD
E OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
�• BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs_
Forms & Footings `2 /p74 �X _
Underground Ducts
Ducts
Slab Grade Fj
Return Air
Steel
Combustion Air
Roof Deck im
Exhaust Fans
O.K. to Wrap �� _D
F.A.U.
Framing a� p
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 /b v_em-. of244/
/
Final /r Z !?G
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 Vl�
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)
MAK 30 2004 14:15 Fid INNOV'A'TIVE COMM 760 839 8246 TO 7714156
CITY OF
BUILDIN%& S DEP (�
Owner C,IiPST'ONES GOLF f%
Tpil"_ 41
Contr&mff !INNOVATIVE RESORT CO1V1M IES
Permit Number
0108-291
POST ON JOB IN CON PICUOUS PLACE
INSPECTOF- MUST SIGN ALL. APPLICABLE SPACES
JOB ADDREW 80-760 WEISKOPF
SFD - PLAN 1-2A LOT 47. PER;NIT DOES NOT INCLUDE
BLOCK WALLS, POOL/SPA Olt DRIVEWAY APPROACH
TVACQs �■iOoecwN DATE IrACO.
FOOTING $UE:L Ing. / !/ f
PRF..[3UNITE I �_
DO NOT FOUR GONORCTC UNTIL 9116L eDOXE IWPICU
CONCRETE SLAEI
JOISTS & GIRDEFIS
ELECTRLCAL GROUND WORI( '.
DO
PLUMOIIIC
GAS & GI kS
A VENT - A
KDOFZ-
Aa z
BOND BEAM
O.K. TO_ WRAP
GROUT ❑ d' I] 8'
FRAMING
'
INSULATION
v.�
PRE -ROOF
COVER NO WORK U
IL ABOVE HA$ BE:
_
CRYWALL INTERIOR
EXTERIOR LATH
-
POOL rAE rLASI'ER
POOL FENCE 8 GATE
SEWER SEPTIC TANK
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEONG -A/C
JOB COMPLETED /
TEMP POWER
MR
ilk Z D?_
ABOVE AP ALS DO NOT INCLUDE RIGHT TO
TUR14 ON UTILITIES OR OCCUPY BUILDING
P. 02
E