9609-012 (3&4)LICENSED CONTRACTOR DECLARATION
y I4ereby�affirm under penalty bf 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.
License # * Lic. Class Exp Date - a,"
ate > Signature of Contractor
OWNER -BUILDER DECLARATION` T 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 contractingwith licensed
contractors to construct .the project (Sec. 7044, Business & Professionals
Code):
O . 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 peimit is issued. '
I have and will maintain workets' compensation insurance, as required'by
S c ion 3700 of the Labor Code, for the performance. of the work for which this ,
permit is issued. My workers' compensation insurance carrier.&`policyIno. are:
Garner Policy No. .
(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 subjecttto- the
workers' compensation laws of California, and agree that iifwl.shouldybecome '
'Subject to the workers' compensation provisions of. Section 3700 of the Laborf
a• Code, I shail'forthwith complY,with.those:pCovislon - . r - _, i •j� .
-Warning- Failure to secure Workers' Compensation coverage Vi rynlawful 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•bf 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
,worklis 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 toAh-e building
construction, and hereby authorize representatives of this"City to enter upon
the above-mentioned property for mspection purposes r "�; •'
ignature (Ow er/Agent) Date
PERMIT# CONTROL#
BUILDING PERMIT --A2� 3944
'
LOT � YPE A- TR/�C�
DATE • q�J- . VALUATION 5337'2,+64;04?
"JOB SITE
ADDRESS J7Fr-76t V1/f�sa��IN0,l�ifN 5TZ $.�.�:��;�'�
APN 769-011.640
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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12,08R•V.LLVE C. A, 96551
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USE OF PERMIT
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LESRUUFFD'VEE``
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to �FR71D,-A,! FE, ON* •9)V.1K NOW
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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
Bored Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines // /2 L
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
a r°
_ CITY OF LA QUINTA
�.OF BUILDING & SAFETY DEPARTMENT �
777-7012
INSPECTION REQUEST LINE
777-7154 yr Lh QUINTA
Owner U.S.A PROPERTIES 041996
Contractor U.S.A PROPERTIES _, T
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
50-701 WASIIINGTON BLDG -V.
JOB ADDRESS
TYPE A UNITS 1-8 `"P 6-t -3
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING / (�
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ARMAVE 1004AS BEE SI NED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
` ,OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE A 17
ROOF
BOND BEAM
O.K. TO WRAP
GROUT O 4' O 8'
FRAMING
INSULATION ZZ
PRE -ROOF
COVER NO WORK U19TIL. O EN SI
DRYWALL INTERIOR 14
EXTERIOR LATH If
POOL PRE PLASTER
POOL -FENCE & GATE
FINALS
ELECTRICAL
ni I 11Anu111_
FINAL GAS TEST l
`TING - A/C
SE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING i
I: