9609-010 (3&4)LICENSED CONTRACTOR DECLARATION
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
C\J W Professionals Code, and my License is in full force and effect.
O Z) M License # Lic. Class Exp. Date
LO
Z N /yii91r10 i
Date ff Signature of Contractor
J Ur OWNER -BUILDER DECLARATION a
ca
W d I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
ON
W
CL Q WORKER'S COMPENSATION DECLARATION
'IT cr I hereby affirm under penalty of perjury one of the following declarations:
LO O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W �: compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
C0 QU (,,[[) I have and will maintain workers' compensation insurance, as required by
U Q Sect
O ion 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
Cb Z)
�O
J (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 California, and agree that if I should become
3 subject to the workers' compensation provisions of Section 3700..of the Labor
ode, I shall forthwith comply with those provisions:" -a
Date: Applicant m
Warning: Failure to secure Workers' Compensation coverage isw.nlawful 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.
1 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`'
VSignature (Owner/Agent) k /r ` P
Date -A-
BUILDING PERMIT � +
PERMIT # CONTROL #
960,94110 3946
DATE a►! VALUATION S466iQ9 X20 LOT TOP F TR/4GI 3 f_)
ADDRESS .41 -IDT WASIUNG OB SITE � � � � f�L.��i R�
APN /b�1 �f�-1�i�P
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Uw,1. PFROTI#;1:`t1 ES V1 IN
CUIPSFUNID
2200-H DOUGLIVS 11,50
2200-B IC.rtRitZAS 11130
ROSEVilaLE VA 9.5661
l OSEVIL LE CA. 9655.1
QI6 773,eyt O
916 771-606 C -BL#
USE OF PERMIT
Mulaf:`%-kAMiLV ONV LUNG
ALLKI 13 VN1TS 1-8'f.'YPf � C,
CONS`tRUCTION 5,372.00 St
PORC:"HWAVO 600.008k,
GA'R AOFICKRPOR T 176,00 11q
";`f111'ieli`IED COST OFCONNSTRUCTION .
466,1119.211
r,`ON'S"t"R!'CTC 9N.1a R 101 -M -418-0w
PLAN QIECK FM 10140030-139.318 $1,703.55
iLiiityFlJ\1i(li.:��l.l'.1sfs .3®.1-ii�f(i-&'i2,t-{3in) �27h.vG
1� 1E:� �`i K.1:(o�11, k;�►s (G i.-ttt�)-a120-(34� �-1�3 sa
Pf 1fR9iamo va 101-0041.94M 17.txi
33�NTMOTION F T�il) 21-000 $4660
1NFRA.;I`.iEJC"YLTItEVER 225-10).44 1-342 $6,000.00
ART .IN Pt!}3J. K* )' LAC,'V-3 - RRS'IC 701 OW -755-000 $915V
I4_HX t"rim; 4 1.T 4250 A)
SULVITiMAL CONSRRUL110114 AND PLANI Gta`►:('K
1.920. 70",
LESS M-PI"att -FRES
i
4250-010
'I'C?"I"AL }'I.+,HN1I i' FERN ACIP, WAV
511,670.76
A
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
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
BLOCKWALL APPROVALS
POOLS - SPAS
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 / G
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:
_
�•F
a
CITY OF LA QUINTA
of v5� BUILDING & SAFETY DEPARTMENT `
(� 777-7012
INSPECTION REQUEST LINE
777-7153
yr Ll1QUINTA
Owner—. U.S.A PROPERTIES
Contractor U.S.A PROPERTIES
7",IANC
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
-701 WASHINGTON BLD.G.,3)
JOB ADDRESS
TYPE UNITS 1-8 13
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOYlk HAS B AIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
?= F -1.6d?,;
Of POUR CONCRETE UNTIL ALVA06VE 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
PRE -ROOF
WORK UNTIL ABOVEAJAS BEEN SIGbIED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
P9�CE & GATE \
SEWERZEPTICTANK / ir9L
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
UTING•A/G
'SE NUMBERS
JOB COMPLETED
TEMP POWER . •
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING