0004-196 (AR)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with 9gatioa-0600) of Division 3 of the Business and
c� W - Professionals Code, and my License is in full force and effect.
O =) ch License # Lic.,Class Ex . Date
CY LO
OZ
oZ r- Date Signature of Conto a for
0�
U C> OWNER -BUILDER DECLARATION
HLuu I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
C () I am exempt.under Section B&P.C. for this reason
N Date Signature of Owner
ON
0)
Q WORKER'S COMPENSATION DECLARATION
C:) Cc I hereby affirm under penalty of perjury' one of the following declarations:
p ( '[-have and,.will maintain a certificate of consent to self -insure for workers'
X W co: peg�oion as provided for by Section 3700 of the Labor Code, for the
O J Q pe F ,Ra�nc�e of the work for which this permit is issued.
m Q U M have and will maintain workers' compensation insurance, as required by
QC Q Section 3700 of the Labor Code, for the performance of the work for which this
d 0) Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
co 5
r CY
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
"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 lanos�relating to the building
e�'
construction, and hereby authorizepreseentati7ees7o is City to enter upon
the above-mentioned prope rt�r,nspecctiion 146, rpose
Signature (Owner/Agent) Date�vV
BUILDING PERMIT PERMIT 7/
DATE VALUATION LOT - TRACT
&31,982.70
JOB SITE
APN
ADDRESS 44-M G01'aDEN HOP CI.RCT49
604 *1 ,%
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
IvrOU DIAZ
OVMER/BUILDER
45.865 C01CWrE UFR MW
45-865 COLGAn ffRM
DMIO CA 92201
INDIO CA 92201
(760)347.3853 CBIIH
USE OF PERMIT
1�F..�1DPHilAL AU1�TTtO3+l
52*9 SY ROOM .Et.1'?L31TION-PER. APPROVED PLANS ONLY
r
ADDITION $99,00 SP
EYMITA1'ED COST OF c ibxS1'R1!l:•'n{Jn
31,M.70
PERMIT F RE .VZOWRY
l'L&N CHECK FEE 1101.000439.31$ 5193, 3A
CONSTRUCTION PER, - 101 -{loo -418-000,, W.50
MECHANICAL FRE 101.0010421.000 $15.00
ELACTRICA1. FUK 101-000-42"00 $26.25
STRONG MOTION F .E - RBID 191.000.241-000 $3.^210
is
y't�•
SU -8 -TOTAL CON 14 AXD PLAN CiMM
$535.33
IMS :PRE-PKID =3
$0:40
4 1'0YAI'F A'R'MT! E+'Y_E9 DUES NOW
1 '
RECEIPT
DA A D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
LARReturn
Air
Steel
A
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
I b ..'s, . 86
F.A.U.
ming
U. 1 _ p
Compressor
sulation
lS -60 LX
Vents
•fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
Final oa
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
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: