0109-054 (SFD)H
_C14
W
O � M
d
6Z�
CD 0-
H(0
J
~a
Z
C'7
Ill
CV
ON
U (3)
a_Q
Z
LO 0
LL
X W —
co <
O
d rn H
It Z_
ob =)
�O
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 / FAp. Date
Date Signature of contractor
OWNER -BUILDER DEC L' RATION
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 exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Datc 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. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
PACIFIC t"��31.ts �1 S. 4$01027)
(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 a,% to become ubpct to the
workers' compensation laws of Californi , V a fee that if 190 Td become
subject to the workers' compensation p ov slon of S��CCtion 7 of the Labor
Code, I shall forthwith comply with t e ov' ons!'(.
Date:Applicant w- %�,_
F✓
Warning: Failure to secure Worker 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 at)ove information is
correct. I agree to comply with all C�ty, and tate law re sting to the building,
construction, and hereby authoriz,,e rggp7re ntatives f fs City to enter upon.
the above-mentioned prope01�
epApe tion p e 0
/�'"✓,4'kDate J ���Signature (Owner/Agen) , / I
BUILDING PERMIT PERMIT#
DATE VALUATION LOT(}� (�(3;�
TRACT
324.776.1.311 1. f% s
1AR39.1. -
JOB SITE I i
ADDRESS ,
$i-2;'7 9 OIX VrEW RIVU
APN
762-59Q-0.14
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
mirk, 11C[?,O
CA.s"M3A11 e
16x9-90 V-011ItA-..k;ii AN AVE. Srn?,, 200
7-3 COR',~'ORAM:PLA2A SUITE 2,4
IRVIl< , CA 926,06
NEWPO T BEACH
CA 92660
(94V,419-4975
C -SW 6W
USE OF PERMIT
p
k5..7.3..iZ .ii�iEWL•.^d .N�i��iA..�4ei.[.i �'
'
WO . If -IT 2(� PLAN 9C. PERMIT Dt:ifr..S NOT INCLUDE It'I.tXIC
W1#LL.'% P001.,fP A, 011 DRIVEWAY APPROACH, i,. '3x96 PLAN CHECK FU'
IIIrYms ("rIONR*ISSUANCE OF 9AMY.PLAN TVP
C'EJ., 1OA11 CON0' RUCTIOW 4 3F
PORI>,Hfl;ATIO 31106 S?
OARAGr ,1? ORT WIN) 8P
W COW 0.x3 Cf�,llii�rWi':.i OW
$04,`726.4' 0
yy,� tA,^�.yR�@��,yy��,e�Yyd��{{{{'� �ry��,���� ♦�y a �, •�,t� 1,1��f.;g��Xa�`
YpJhA`3d5�:f,ITJL TU.�R� 5Y4.!�X.RAStA.itE�Y,$,
CONS Y'RCiC`3`ICi'I'1 KK101-000-41"00 $l,.4' .60
9'3 -.AN t~ai:ltaPWK REK 101d000439.218 Of 8100
11"CI X Al. Pry '10],,000.4213 0W $1U1E30
P-1,94MLdCAL M0, 101-000420-000 $20,06
PI,SMBINO WE 1101.000.419-000 2199.71%
ST,W7NG MOTION F1101, o 11 10 103-000-241-000 V147
Gift.Al:?fNO FRE, 101.000-423.000 $2-01 Do
OWFL.OPER IMPACT PL+E $1,907.00
ART IN POULIC !'."1st4.M 1zi1?3f 27t" .5.000 Sal 1182
WIAL 1,113MMMUESDUE NOW
'J
SEP 11 2001
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE . ,.
BY
DATE FIr�4LEJy
SPECTOR
r -
P /�r
9`�) S
INSPECTION RECORD
OPERATION
j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings 2.-
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
_ _
p /p
�6�f V�
// ��D
/-,,
"/
/2/?�$fb'/ mac/
Underground Ducts
Ducts
Retum Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
D
l
Final5�=cam _ -
BLOCKWALL APPROVALS
Final
s ,
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
_
Waste Lines 9/z8���
Water Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
_
Pool Cover
Encapsulation
Sewer Connection ql/ate
Gas Piping
Gas
Appliances
Final
COMMENTS:
-
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final -
Utility Notice (Perm) s` /