0103-208 (PLBG)N
U)
(V LU
O co
r- LU
o Z
CCD 0
H C)
J
LU LU
U)
Z
co
U)
N
ON
U °)
d Q
Lo �cc
0
0 J J
mUU
O
� a)
1-t Z_
ob Z)
Q
J
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
B IMC 6o
; yQSte»»' r� Signature of Contractor%%^'���r�
Y
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 exciusively 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.
S�) I have and will maintain workers' compensation insurance, as required by
ion 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.
LEMON N C-0. 'est;°MOS14Nt?
(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'tajiforn a, ,and agree that if I should become
subject to the workers' compensation pr vy",ons%of Section 370FY�f the Labor
Code,. I s1all forthwith comply v�itf5 t�4i`oser 'f6VISI S.
Applicant
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
whose request and for whose benefit work is performed under or pursuant t
any permit issued as a result of this applicaton agrees to, & shall, indemnif
& 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'1
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 Q all City, and State laws relating to the building
construction, and hereby•aulhon a representatives of this City to enter upon
the�above mentioned property'f 'r/In
pection purposes.
Signature (Owner/Ageni)<f !' {- Date's ��1'M
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0103„209 TRACT
lib -M
JOB SITE
ADDRESS
APN
+
OWNER
CONTRACTOR/DESIGNER/EN &NEER
R0'O1"�}: T t.:MEYE)WAMS
BOB wwt&ns CONT111 U ETON
79.97.0 D, MA ?:!htYE
9-920 rFLUTAL" RIVE
!A QJ 'f A CA 92251
Li QU.114 fA CA 922-53
(760)7137933 CBX41 ;4212
USE OF PERMIT
bNu'lVAL1, QAS iN N? TO HO WATER T3k>'A712
VAtdT3ATICIN 20M Do L3
1,sgmurm COW Oat+ C:Oi43"TARIUS:"TION
200.00
PLAN CHFI'"K 5UZ $13,00
1�iwCfRi3�1��1 �� 1C1�00a}-�.19-�4CiC3 ��.OA
t
Q -TOMsN9�%
$18.00
,r i1y.}}[°��� y.d`���d((��R�B-
//as4��M-0
MAR 2 8' 22001L FESM 14 S DUE NOW
SlUo
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Duds
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. 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
Bond Beam
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
_
_ 1
Final
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)
COMMENTS:
M
a
z
Bin #
City of La Quinta
Building 8I Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (619) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 7 —1W -'F 4(,ut,
Owner's Name: �.
A. P. Number:
Address: Y —Vo 4-fics
Legal Description:
Contractor. G�
City, ST, Zip:
TeleP ho ne: ......,:......:...........:.::.....:.:.:::::.
Address: -7q —Tzo *qo\D- t y-
Project Description: GI._" 411
City, ST, Zip: L* 6
e:
Telephone:
P h S 3 3
ee..
State Lic. # : 7
city Lic. #: ZiZ
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
Lic. #
Name of Contact Person:
Construction TYP e:Occupancy:
Project type (circle one):: New Add'n
Alter RepairDemoState
Sq. Ft.: # Stories: # Units..
Telephone # of Contact Person:
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Cates.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Grant Deed
Plans resubmitted
Mechanical
School Fees
2"" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Planning Approval
Plans picked up
S.M.I.
Pub. Wks. Appr
Plans resubmitted
Grading
H.O.A. Approval
'"' Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees