0106-319 (PAT)LICENSED CONTRACT 4LLARATION
to I hereby affirm under penalty of perjury t . ,ensed under provisions of'�
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
NUJ Professionals Code, and my License is in full force and effect.
O =) ch Licens, # Lic. Class Exp. Date
- �
r
C) Z r! Date/r y -' � f Signature of Contractor
C) O
J U co OWNER -BUILDER DECLARATION
HUJ r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL
U) License Law for the following reason:
Z_ ( ) 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).
cr) () I am. exempt under Section B&P.C. for this reason
LO
O N Date Signature of Owner,
0)CL Q N WORKER'S COMPENSA','ION DECLARATION
o cc I hereby affirm under penalty of perjury one of the following declarations:
U) H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W !:� compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q U (�� I have and will maintain workers' compensation insurance, as required by
Q U Q Section 3700 of the Labor Code, for the performance of the work for which this
li 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
aoo 5 �1{.QTR FUND -013-11)"MM
O
J
(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
3 subject to the workers' compensation provisions of Section 3700 0 e -Labor
Code, I shall forthwith comply with those provisions.
(M1 Date:' ' — ✓ Applicant / f —
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer totcriminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is.hereby made to the Director of Building and Safety
for a permit subject to. the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or -cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating -to the building
construction, and hereby authorize representatives of thi ity to enter upon
the above-mentioned property;for inspection purposes.
r1 Signature (Owner/Agent) Datj� _0)1)_0
DING PERMIT PERMIT#
DATE VALUATION LOT �x�".�X9 TRACT
%L'��,�:' ��i''a�iitt sa'i
JOB SITE
APN
ADDRESS
13'O3t:1'' =�l- F.
OWNER
CONTRACTOR / DESIGNER / EN (NEER
HOWARD IW(MIAMS
sugui13CRm-N &.6mmuG Co.
44.30,11'4.?)MM, MCL E.
. 415080 C,9,H0bN UPYKEEr
LA QT.xMA CA 92253
3k;1 10 ''., CA 92201
(, 60)34 7.,Q i92 C� .Lff- 4996
USE OF PERMIT
PA: 10
4141 SQ l' -'-""T OF ALU'MA;W001) PATIO COV 9R. 13(.WA621P.
POR.CG7 PATIt•'J
bUSIMA'$:i D COST OF CONt�'.�`+'�.IC"IXON
5,506,20
MINNNk
CHECK .4 e 101-000.439.31€f 13.2.63 .
Ct')'N QTR- iC` ION a4ME 101-000-418-000 $81.00
STR.ONOMOTION ME -RESIT: 101-0004241.000
1
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.
SUB -TOTAL 0 '...... Uc °`'
'fa & +eA I t ' 1.7`3+�� N )ill s' NOW
$1,2df
RECEIPT
DATE, f /
BY
DATE FINALED
INSPECTOR
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
BLOCKWAOL APROVALS 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
Final
COMMENTS:
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)
T19; C. C;
LA�V;wi�i,
�(o(JsE
t
CITY OF
LA QUIfNTA
BUILDING & SAFETY DEPT.
N 3000 pox
APPROVED
FOR CONSTRUCTION
DATE ZZ O ( BYl----
1-c-- - ?"�o -
(/olp
SUNLAND SCREEN & AWNING CO,
46080 CALHOUN ST.
1NDIO, CA 92201-
(760) 347.0592 FAX (760) 775.5434