0101-350 (BLCK)1;:IICENSED CONTRACTOR DECLARATION
by 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 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:
1, 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
,(,Sec. 7044, Business & Professionals Code).
1, as owner of the property, am exclusively contracting with licenged
dontractors to construct the project (Sec., 704.4 Business & Professionals
Code).
O I am exempt under Section
B&P. ."for this reisn'
Signature of Owner
Date 1 '71 11, 10 1 6?
I .
WORKER'S COMPENSATION DECLARATION
11h.ereby affirm under penalty of perjury one of the following declarations:
1 have and will maintain a certificate of consent to self -insure for worker`s'
coiiipensation, as provided for by 'Section 3700 of the Labor Pode,,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 performance of the work for, which this
permit is issued: My workers' 'compensation insurance carrier & policy no..are:
,Carrier Policy No.
STATE FUN 3
(Thissection need not be completed if the permit valuation is for $166.00 or less).
I certify that in the performance of the work for which this penbit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of 9plifornia, and, a ree that if I should become
subje&t.to the workers' compensation p. of Section 3700 of the Labor
Codpi Ps all foftwith comply witliithose pro/,, s4p�j-�
S. ApAi,.nt
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject amemployer to criminal penalties an`'- civilfin�)es up to $100,000; in
addition to the cost of compensation, damages asprovided for in Section 3.706
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 f6rth-'I,on his
application.
1. Each person upon whose behalf this,appli6ation . 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 160 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 thatIthe above Information is
correct.'l agree to comply with �11 City, and State laws relating to the building
construction, •and hereby authcrr" ze representatives of this City to enter, upon
, , JE
the above-mentioned property fp� ii ti ISoses,
gen-t)
Signature' (Owner/A .'Date
7�_
BUILDING PERMIT PERMIT"
+u
DATE • VALUATION4 -101 V,,V0 TRACT
LOT
JOB SITE
ADDRESS-
APN C
AVIENWA YUJA
OWNER'
CONTRACTOR/DESIGNER/EN INEER
.F-11TVIE HOUSEAS U -C
13 &1 Ns. 9-4011-M. UC1,11 iWl
'74-5961' PRUREVI)WHY
51-986 AVINIL IDA YLTAMEZ,
PA1JVDYJM,kT- M 92260
CATRTYA CA 922M
Q 0 7-5478 CTV 4 $941
6 )8 3
USE OF PERMIT
r-,IHLD N -*G
1,32. L4 K VH COMYNATACIN 0AR13KNVAL1, (+-Th RXTARTWO) Q
6FT. WALL1 R1q 11F
RIUMN1,031 COST OF WHATIRUCIA7014,
COINUTRUCTION FEE, 161 -WO-4.'I o-000
R'
JAN
LA �Aul
Ur'
Sul -i -TOTAL COMWERUMONAND 3?IAV4 MM
$63-00
LED.. F'Kk4,-rAYD ?M9
- K
SO -00
TOTAL rtrmf r rre, s imgxow
$63,00
RECEIPT
DATE/_
rATE FINALED
INSPECTOR
,,y
k
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
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
Footings .rl� �g( <
Bond Beam _ _
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
COMMENTS:
r
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)