9609-014 (3&4)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
Professionals Code, and my License is in full force and effect.
License # Lic. Class <,` Exp. Date
'Date �' � � l/ Signature of Contractor
OWNER -BUILDER DECLARATION
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
Sectl n 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.
(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
subject to the workers' compensation provisions of. Section 370o --6f the Labor
Code, I shall4orthwith comply with those provisions. F
�fApplicant
Warning: Failure to secure Workers' Compensation coverag6is Unlawful and
shall subject an employer to criminal penalties and civil fine '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 property for inspection purposes
�.��'.
nature (Owner/Agent) Date,'!"' '
PERMIT# CONTROL#
BUILDING PERMIT' -
BUILDING �dF`
960"14 3942
DATE VALUATION LOT TY PF 13TRP�CT
�2
ADDRESS 56-701 A+fil�iNGTO Ni i S LOG H
APN '769-034-040
OWNER
CONTRACTOR/DESIGNER/ENGINEER
USr1TRO3P1?RRTES RJND
220043 DOUGLAS 41-30 -
22011.8 DW( ;LAS -ii: ISO
12.0. 1 VILLF CA 9,%61.
R08 V11,t E CA 96.5.51
0 1 G 773-
9.16 773 -MIS
USE OF PERMIT
1<11JL'11-'RAMILVOW Eis,!-°(W
13L1)3 FI. UNITS 1.4 TYPE B
4AAC'1" 3.008.00 3
P(JR04/pATIO -304.00 8F
GIAR'.As N-'ARPORT 64.00 Sir
ESTIMSFED COS`!' 09 CONSTR17MOIN
168.631.00
PER lt' IT �+"1.1r. NIJMMARY
PRE 01-000-419-600
MAST CWXX .F 1.01-000.4.19-318 $775.81
MEi:F1t`aWC.AL ,1 1431.-000-4121-000 $11166
VIXC IR -I ,AL FER, 143.1-000-4204>s3ir $232.v
1�f %Ifvlf3li r: F l 3 1014WJ 4 i 940
'TIP :1'�kffIi)�` fsfs RE811) t0E-t.` 0 a.41.• ? �!6.'ti
1.,iiAa�MAI C""f3.E 1 1-�10if_-f13-cl(lil $20,00
(WRASi"R07Cf,R ,.F'FF. 225 -000A10 -M12
AWI' IN, tXURf*,7 Pf A('F,S -RESM, 70149)-T55-000 9)-255.000 $171.53
41,9;ia7'fYl`t'iL CONS'fR IC`i'ioN �ANLI.miL N curim
$6,w, tti
LESS 'F':k -PAW FUSS
$0.00
RECEIPT
DATE
BY -
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
T DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/ (A
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
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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/ 9
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
/ !f
Pool Covet
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)
a s CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-71 Stj I i Ur L!1 WUIIV YA
Owner U.S.A PROPERTIES ( OT Q x:.1996
U.S.A PROPERTIES
Contractor T
.9609-014
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS TON $ }€ ' ,' M "
TYPE BUNITS 1-4
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL /
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL A OV AS B Ehl StGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L OT POUR CONCRETE UNTIL ALL ABOVE AS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM Vill
OX TO WRAP V
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOYE "ASIBEgN,4IGNP-0
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
L FENCE & GATE
SEW SEPTIC TANK u
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
P- `TING - A/C
_ SE NUMBERS CO
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING