9609-011 (3&4)LICENSED CONTRACTOR DECLARATION
U I hereby affirm under penalty of perjury that I am licensed under provisions of
FL Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
c� W 'Prof6s-siisnals Code, and my License is in full force and effect.
7) M License # Lic. Class Exp. Date
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Z III/ate ��� Signature of Contractor '
to UOWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ a 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).
ce) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
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WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
U-) � O () 1 have and will maintain a certificate of consent to self -insure for -workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U 1 have and will maintain workers' compensation insurance, as required by
O (-) Q Sect on 3700 of the Labor Code, for the performance of the work for which this
Il 0)H permit is issued. My workers' compensation insurance carrier & policy no. are:
,It Z Gamer Policy No.
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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 .l should become
subject to the workers' compensation provisions of Section 3700•of the Labor
C!
de, I shall forthwith comply with those provisions.-{ , ?V
Vl ate: o �✓ �:: "�' Applicant 17 -
Warning:
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to -,$1 00,000, 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 forthon 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.
V gnature (Owner/Agent) Date -_L/
BUILDING PERMIT PERMT# °°NTR°`#
60W0I1 3945
DATE VALUATION �i ,itZ�1 LOT t Y11 t� T x{,Ij(.i F
ADDRESS 50-7{01 %I,a��"��.�f� TON S'! HLIX; U JOB SITE
APN 769-t}30^044)
OWNER/
CONTRACTOR / DESIGNER / ENGINEER
t o Kx Y
lS
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�1'tk� i�l3ilc;l,tiSr1iS
.'Z{ii?-ti 1t�i1Ci(,I�S 1'0
1.fAHMIAIF ("A. 95661
Rtt�-�SEVI)'ILE, +f.'f1. 4655t
Q 1 E; Tl fi3) it
f! 1 fr .771, 606
USE OF PERMIT
.411ji.�IR-1�1 it1. 111VE;Lt,tivt;
131,L)O F. UNtTS f..g TYPl A
PORCHA)ATIO 608.W 1*'
0,tiRM)',1'!F".A#tPORT #2R.lit) fit'
.
#'.t+;1P.t19I`#' C�'9i:I� �t'i11'IiVR�►`KY -
C",tiNS'1"R??�.:"f[iJN f�'f+.fill71�{�ii�4tK-Cf('?t) � �Xoa72-50
IILAN CiTI IR I'M. 10140439-318 439.318 501311,6
MECHANICAL ANICAI.1,7 101-0 00421-000 $21100
C4,F('17R [CAL FEE 101.000-420 S405,12 .
1>1.ilib IONir FEE 101-000-419-000 $427.00
STONG1i1MO FEE RESID 101-W- 1.1-M 133.73
MAIDING FWL 101,.000-423-000 $20 00
1N'FftAS,0rRTJ -FURS t~PF. 21-5-000-40-342 sr,,(M tw
Iil2T 1N Tiil.lRIAC PLAT FrS ., RE.W. 701-000.255.00() $993,16
SUB-TOTM, C`.C3NSMUCTtC)AiKND PILA.Nt CHECK
S10,476.13
US. .1r12lr-PAW fx:,l.s
$0.0
'I MAJ, Is1 lY1i n,n Es out, ow
$10,47633
RECEIPT
DATEBY
(�
1X"\moi, •_.t
DATE FINALED
INSPECTOR
INSPECTION RECORD
11, OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
It BUILDING APPROVALS
MECHANICAL APPROVALS _
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Root 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
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit /27/'f
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:
a
s CITY OF LA QUINTA ;r
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7 ti 53vr LN UUtNTA
Owner IT fi_A PROPF,RTIES �, hA4 1996
Contractor U.S.A PROPERTIES
Permit Number '9609-011 '
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-701 WASIIINGTONOLDGX
TYPE A UNITS 1-8
TYPE OF INSPECTION DATE INSP. .
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE—GUNITE
DO NOT POUR CONCRETE UNTIL ALL 4BOVJ HAS BEEN GNED
CONCRETE SLAB 1 711141 W17 1 17V
JOISTS & GIRDERS
ELECTRICAL GROUND WORK 11111vV4
T POUR CONCRETE UNTIL ALL B VE HAS B IE SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST 71 47 vi
HEATING & VENT • A/C
FIREPLACE
ROOF Z
BOND BEAM ,
O.K. TO WRAP
GROUT O 4' 0 8'
INSULATION
PRE -ROOF
POOL FENCE & GATE
SEWER SEPTIC TANK
ELECTRICAL
PLUMBING
FINAL GAS TEST
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING