9605-033 (SFD)LICENSED CONTRACTOR DECLARATION
C/) I hereLlky affirm .i;nder penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CV W Professionals Code, and my License is in full force and effgct:�
O 0 M License # Lic. Class -"--N,. PExp. Date
O Loi1 i.?.io� 13 V29,197
W r` �
Z r -N Date s"� r 1 f� Signature of Contractor N
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O '.
OWNER -BUILDER DECLARATION
W WCDT
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).
M O I am exempt under Section B&P.C. for this reason
L
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
C) 2 Z I hereby affirm under penalty of perjury one of the following declarations:
U-) - O () 1 have and will maintain a certificate of consent to self insure for workers'
X W tL compensation, as provided for by Section 3700 of the Labor Code, for the
:O J Q performance of the work for which this permit is issued.
m Q •U ( ) 1 have and will maintain workers'. compensation insurance, as required by
O UQ Section 3700 of the Labor Code, for the performance of the work for "which this
d rn H permit is issued. My workers' compensation insurance carrier & policy no` are:
'cl- Z Carrier Policy No.
ob =
C3
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 Cali'o1 r a�and �ree that ill should become
3 subject to the workers' compensatlon.provisiong osf Section 3700 of the Labor
Code, I shall forthwith comply with thI se r'ovisio .
{ Date: - drAPPlicant
t s IN
Warning: Failure to secure Workers' Compensation"coverage is unlawful and
shell 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 thatgl 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 repfesentatives of this City to enter upon
1 -,
the above-mentioned property for insp(cAonpurposes.
Signature (Owner/t 7,
Agent) �.• P� Date.F�^"'�"
�1-1 BUILDING PERMIT PERMIT# CONTROL#
964115-4033 3 2 9 6
D TE / _ . 9 VALUATION 51..68.2.1.`x.40 LOT 16 TRACT.�9.1 1" r
JOB SITE.50•-260 GRAN13 TRAY ..ri.S�. AVE
APN
ADDRESS
OWNER CONTRACTOR / DESIGNER /ENGINEER
"FlJ"HvAYS A QW)TA, C11�l4i
atl•S2S+ i�t�iv"Li�� 1�� 3?3 mugrol'. to. f�.A
t,AQU1N-FA CA +y2.15'j t_Y).%*F . K.iESA CA 92626
r'lS.1 yl l 71•Sc24
(7,14),540-,606Q Mj # 3324
USE OF PERMIT 3R>alMR CO1�+.AL .M; tS A.Sti,*C.
tilNGL€'s F/1.M( Y 1XVEL', ,I.N0 13`361 Fs'.1.ST CHAP&," AVR
LA QLgX f'A FAf Ci WAYS
PLAN 3R
CUSTOS &1 ErC)DfSCRUGP.i.Cb3+1 2f014.00 4
PtI'IZl;'lilPATIO 1,38.00 S1
GAPA j /CARP%JVV 4.9,3.00 SF
i::S°i"3Mhii X90 COSI' OF CU:ti S RLiMO
PERMIT FEE 81JUMARV
In, M4 CFiFcK r ni, 1.01-M041-9-318
r'O1.75"i1Zi1d:'Y t:")id :l fel 101-000w.4113.1)00 $881.(11:1
t UJAN1CA1, FIKE. 101-0"1.421-000 i0150
191-,.fC'1"ItiCAf; Erik l(31-0()t}2f!•i{tN) $14?,«
°1:1JMkjtgo1 fl- , $01rtt0i)-14194)10 $1+15,,.50
a'1`014C, iv10110N.F03, - RESOD 101-000.'241000 $tr,.3`
C AWr Gf-1.8 W
IN FitASI 'f.2Ur,'t'Lf 11.1`'ER8 5.000-413-342
BT 1r PIAI Nr ' PLACESv RFSSRo 701-M.0-255-900 ;$1i0.SJ
QNSURUC1:ORt AND PLAN CITECK Vr&3�0:0�;
D.LESS PKE—P.Ai .S
SUN1 1996. r.: � r z�81s �rt�.�.
3y
RECEIPT DATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION DATE I INSPECTOR
BUILDING APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
Final
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top Out . .
Shower Pans
Sewer Lateral
Sewer Connection'
Gas Piping
Gas Test
Appliances
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)
OPERATION DATE i INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
COMMENTS:
POOLS - SPAS
kwx&ry OF LA OUINTA
W ` BUILDING & SAF=ETY DEPARTN1ENt
VN 1`i 777-7012
J 1QI ECTION REQUEST LINE
777-7153
r FAIRWAYS I. A (1111 N TA,—..--------_ -
actor AYERS GROUP -- --- --_---
I Number 9605-033 4 --
POST ON JOB IN GONSPI(�iJUlJS P,.Aa;E
'PECTOR MUST SIGN ALL. A,0PLIC�,LlLE SPACr'-;
aDDRES5 50-260 GRAND TRAVERSE
D PLAN 311
TYPE OF INSPECTION DATr P.
DATION 8 SETBACK
ING STEEL - t ?—
GROUND SYSTEM
IND PLUMBING /-''—
,_,UNITE
OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
;RETE SLAB L� /—
S & GIRDERS
fRICAL GROUND WORK
DT POUR CONCRETE UNTIL ALL ABOVE HAS Bt EN SIGNFO
&1 ELECTRIC
iH PLUMBING��-
H GAS 8 GAS TEST r'
NG & VENT • A/C
LACE ------- --
�
BEAM _ {�
0 WRAP
T D 4' C 8'
ING
ATION
ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED _
ALL INTERIOR
-"IOR LATH
'� PRE PLASTER
FENCE & GATE
R SEPTIC TANK —^
_ FINALS
BING _
GAS TEST
i NG - A/C
iE NUMBERS
,OMPLETED
'POWER
ABOVE APPROVALS DO NOT INCLUDE RIGH,r TO
TURN ON UTILITIES OF�CCCUP`r" HUILDING