0308-255 (SFD)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
T� HUC l .4
i ,� 9/30/0
Date' f —'� Signature of Contractor � fF� �' 0)4
I f
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: • 4
( ) 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 thetproperty, am exclusively. contracting with licensed
contractors to construct theproject (Sec. 7044, Business & Professionals
Code). s ..
O I am exempt under SectionI B&P.C. for this reason_
Date :r: 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.
A) I have and will maintain workers' compensation insurance, as required by
Section 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.OLD U -PUBLIC NSU
,
(This. section need'noi 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 3700 of the Labor
Code, I shall forthwith comply with those,provisions..
'Date: 1-2'14' �I ;1 Applicant A� � /✓/�//�fr
• s
Warning: Failure to secure Workers' Compensation coverage is unlawful 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.
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.
Signature (Owner/Agent) 1 � /'f , AX Date /F`/57,43
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS '44.2104 N PA VION
APN
`
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LXINAR HOMES OF CALIFORNIA
LEMMAR TIMMS OV C—AU �CORRIA
78=401 Cr MCHWAY 111
78.401 (' 111MMAY• 111
L-AQu£ta`v..i CA. 92253
L,r•,Q1UNTA CAI 92233
(760)7"17-,0132 t Y 1.4 3434
r
USE OF PERMIT
370 •, LVE -1k PIAN 3HR. PERMIT DOES' NOT INCLUD?, BLOCK
WAL.L8,/POW, SPA, OR 0PLiVL;` AY-APPftOACH. 73 {;b RUDU '6` XXX TO.
P?iJi'N GI ECY FES: ME 110 MULTIPLE iSSUANCE OF aAME Pt`.. 41 TYPE.
TRACT CONSTRUCTION 2633,00 3F
)9i?r?t,ttt�t?i'�'I'ICi. 236.00 Sr
Cx�att 0.4}FJ�° ARi't)It 1' 426.00 OF
EgI .h LED CONT C,)F MNSrt"k€t7MON
$57,R F I9
CJONSTRUC f JON 'FEE 101-000-118-000 W42. 50
1:1LA'N CHECK II'EE 101-000-4.39-318 73.1*30
MECHANICAL 1pES 101-000-421-000 MUD
E I=TR I CA L I+LE 101-000-42,0-000
F'lx4smo t+se 101-000-419.000 $167.2$
STRONG MOTTON PEP, . RESID 10) -000-241-000 $1.5.72
MADY9 -EE $15.00
i?I:'4il:l..0,F'.ir.9t': W",QCT FEF ���ti511t3
SUP, -TOTAL CONS'•£RUCTICAT AND PLAN C'`.IMCK
$3,814.70
•L.M19 i'R'i r PAD M01
.$10100
r-- "AL I':St.>i&UT �''Es .17'�1z HOW
W4,014,70
r 3
r
5 15 203
�( /�� i
�a qg LA
6.11 If aS'Y' �•i WNTA
FINANCE D__EPT
RECEIPT DATE-__ '___'
ATE .,.._.
4J9. /5, G'.3
BY
)6f fo
DATE FINALED
7.�d2,o
INSP T R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings.,
Ducts
Slab Grade
_
Return Air
Combustion Air
Steel
Roof Deck
O.K. to Wrap
_
f
xhaust Fans
F.A.U.
Framing
Insulation
_
_
Compressor
Vents
Grills
Fireplace P.L.
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali Firewall
A 0C
Exterior Lath
Drywall - Int. Lath
..�
Final
Final
d
POOLS - SPAS
BLOCKWALL
PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPR VALS
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
�Q
Encapsulation
Gas Piping
_
Gas Test
_
Appliances
Final
COMMENTS:
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)