9607-051 (BLCK)U)
H
N U)
W
OAC'')
W
Z
T O 1
c0 � rn
W W
F- O_
W
Z
M
LO
N
ON
U °)
Q_ Q
It 2 Z
Lo acc
0
LL
0J J
m U U
Z
cc) =)
r, C3
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
Dat -7 U, ��Signature of ConttrractoF - �
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that lam 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 apDexempt ur15rySection B&P.C. for this reason., '9 _.11_/Date '` i! 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
Section 3700 of the Labor Code, for the performance of the work for, which this
permit is/issued ,fyly yi9riceerslc9mpensation insurance car,ier ,,pgjjcy4no.'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 3700 of the. Labor
Code, I shall forthwith comply with those provisions.,,:".
Date: 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.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 thi City to enter upon
the above-mentioned property for inspection purpd�.
f
Signature (Owner/Agent)J..
BUILDING PERMIT PERMITk
g,��3 717
DATE %♦t�( VALUATION.. LOT TRACT
00
JOB SITE
APN
,ADDRESS 79,180 FOX .i LIN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MtA11 T'!2>st liC-4?ASMt'L•:1; C:{ tr. ;
.MiP+I(;�'l�Fil ! i I-PA,iNTE C(���E?,
50445 MOUNTAIN SWWOWS RD
50445 NIOUNTAM SHADOWS RD
l,.t� l��iMITA. CA 92253
1,A. QUfNfTA OA 2251
(619)564.1849
fei1Ulm#>184 . [:f3C 1# act S
.
USE OF PERMIT
2601f (A6 0AR1` EN WALIL
6 V f. WALL a60.av ;:.i~
' Ofr 7.6.1i1YlX D' D CUST OF \.,lJttl�'S1RULY.ftO
V,jo:�iril�VV
C:ONSTRf:JGFIO1'F`I t:?E 1.01.000 -4t8 -ft)
'
� �
{+:'�'•� y /h p j*9�� py� p� may*. g(�•� p A pq �/ t
8A7, 1:0i-':�aSw! Jt UC ION. AND I".e.r.'"i.�•Y CIJF K
O t_£"5S PRE -PAID
190.00
$O,(i0
JULPE
1.8 1996
RECEIPT
DATE
By.
DATE FINALED.
INSPECTOR
' CONTROL#
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
OX 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
F _
Under round Plbg. Test
Final 6
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground ConduR
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:
a
CITY OF LA QUINTA
ESO,. ,�` BPILDING & SAFETY DEPARTMENT
OO 777-7012
4VSPECTION REQUEST LINE
® 777-7153
Owner <- ' f AA CONSTRUCTION
Contractor MISTREi .LI CCINSTRUCTION
Permit Number 9607-051
POST ON JOB IKi CANSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-180 FOX RUN
260 LF OF 6' GARDEN WALL
TYPE OF INSPECTION I DATE I INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE ,
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
150 NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ABOVE APPROV -.R