9609-019 (3&4)LICENSED CONTRACTOR DECLARATION
-1 h&r'eby affirm under penalty" of pequry`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
nd-effect.License #Lic. Class . % f Exp Date
. - ,.Z.
Date • � .. Signat`ure of Contractor
OWNER -BUILDER DECLARATION'
I hereby affirm under penalty. of perjurythat 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).
O I am, exempt under Section B&P.C. for this reason'.'
` DateSignature of Owner j' -
WORKER'S COMPENSATION DECLARATION '
1 hereby affirm under penalty, of perjury one of the following'clklarations:
O 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 peformanceof the work -for which -this
,permit'is issued. My Workers',coriipensation insuranceicarrier &"policy.no.'are:
Carver.,.: Policy No.
,,(This section need not be completed if t i6' permit valuation is for $100.00 or less)'.
O I certify that in the performance of the work for which this permit is issued;
'1.shall not employ any person in any manner so as to become subject tolhehw
workers' compensation laws of California, .and agree that if. 1 should become
,SuPject to the workers', compensationprovisions,6f ection''3700 of the Lrabor .�
ode, I shall fon hwt^rcomply �with°those provisions.,, y'
ate: ✓/` r., ,' APPlicant
.,»
Vn
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 forin 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"CCity of La'Quinta,its officers, agents and employees.'
i 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 to. cancellation.
(.certify that I have read.this application and state that the above information isl---
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�f�or inspection purposes ,
• .YV��DII\�.A PERMIT PERMIT# ,' ', . .CONTROL# ,
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DATE' VALUATION „ , LOT: t TRACT ,
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JOB SITE 3� 1�
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APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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USE OF PERMIT
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RECEIPT (�
DATE
BY
DATE FINALED
INSPECTOR R.
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 Wail 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 I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines / (p
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral / b
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit 6
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).
IN . a
r. CITY OF LA QUINTA
°4o�..,� s� BUILDING & SAFETY DEPARTMENT
777-7012
u INSPECTION REQUEST LINE
777-7153
Ui : it Lh i. UIii FA
Owner I�S,A PR()pERTTF;
ContractorU.S.A PROPERTIES
Permit Number 49609-019
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-701 WASBINGTON Gu
TYPE B UNITS 1-4
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL /
MAIN GROUND SYSTEM
GROUND PLUMBING
(�
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL
CONCRETE SLAB
A,14OVAS BE NED
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L jOT POUR CONCRETE UNTIL ALL ABOVE 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 qzz
PRE -ROOF
COVER NO WORK UNTIL ABOVP HAS BEEN SIG
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
CE & GATE
EWER StPTIC TANK /Zllyl a L
FINALS
ELECTRICAL v
PLUMBING
FINAL GAS TEST
P •TING -A/C
I 'E NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING