0008-450 (BLCK)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
professiopalS Code, and my License is in full force and effect.
Ucense #' Lic. Class Exp. Date
6, a0Y7�07:� I12f
Date /� Signature of Contractor
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 .OTA,1'31�t3ND Policy No. l�4ti�60t�3�
(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 issl,ed,
I shall not employ any person in any man�,yr eLs�o as to becon e,� ubject to the
workers° compensation laws of California, and a ree that�if I should become
subject to thp, wor ers' compensation provisions of $ec lot n 3700 of the Labor
Code, I sh kf fortflwith comply witKthose provisions`'-
Date: lottn Applicant
Warning Failure to secure Workers' Compensation coverage is unlawful ad
shall subject an employer to criminal penalties and civil fines up to $100,000! in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of'La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I, certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby -authorize representatives of this City to enter upon
the above-mentioned"roperty for ipeection purpose
Signature (Owner Agent) bate 9
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB,SITE
ADDRESS qi0 No WOOD ''R X
�Vq�
APN
•.
OWNER
CONTRACTOR/DESIGNER/EN (NEER.
LA. QLTJNTA ORCHMD PAWM'E.,i��
SPARKS KS C ONMMUCTIOR
PO BQX 1'716
79-295 RANCHO LA. Q094TADR,
"LA Qt7i1+1`.rA C.A.' 92253
LA QU.i1 r.", CA 92253
cm) -n1,1941 M l 2996
USE OF PERMIT
C>R'I* MAL LU7:CMIG
60013$'. CtAR DEN WAU (ORCO S'!'r`NORAD) PER APPROVF D PI—ANS 01411Y
6 hT. WALL, 600.00 JX
ATKI) COST Ol, CC��ISTia�1C'�t)I�'
1�81�t�.41�1
�g�gp��gy� �yy {y. 8y�yE�Ny".
,P." 1Luri l�:1.6J, YEE SURIM 1�.7.
C'ONSIT UCT1ON FRE 101-000.418.000 �� X142;Ap
y
PA
"'SEP 1 U 2000
Xpl 0F LOA QU�,NT.
MB -TOTAL C O.WM'R C'Tf0N' 9D PLAN MWX.K `
$162.00
LESS PRE -PAW FEES
$0,00
TOTAL PMWf TBES VUE NOW
RECEIPT
DATE
By
DATE FINALED
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
OX 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
BLOCKWALL APPROVALS
POOLS -SPAS
steel
Set Backs
Footings _�/%Dp
Electric Bond
Main Drain
Bond Beam
/ ® -
Approval to Cover
Equipment Location
Underground Electric
Final
�j
Underground Plbg. Test
Gas Piping
PLUMBING AP ROVALS
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
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)
COMMENTS: