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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjuryI`that I arri licensed under provisions of
Chapter 9 (commencing with Section'1000) of Division 3 of the Business and
Professionals Code, and my License is in full force and,effect:' �
License # Lic. Class N Exp. Dafe-
t�t31ci1 1� ,x C_.►- fliA311!*7 .
Date T �r Signature of Contractor
OWNER -BUILDER DECLARATION
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
Date 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.
( t),.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.
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performapee•of-the work for which this•permit is issued,
I shall not employ any person ifi any manner sofas to become subject to the
workers' compensation laws o California, and atgree that if 17should become
subject to the workers' comper�,sat16n provisions of',Se„ ctiio,0,3700 of the Labor
Code„I-.shallJorthwi h comply with tie provision
�_ � Applicant v
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 a plication -and, state that the. above information is
correct. I agree to comply. all, City, and State laws relating to the building
construction, and herebVauthorize representatives oflthis City to .enter upon
the above-mentioned pro rty f r„inspection purposes: -
'—Signature (Owner/Agent �"'"�Date -
PERMIT # CONTROL #
BUILDING PERMITE�Q 7.
DATE 31(jp)(1 VALUATION $168,212.40 LOT: k5 TR, 0038,9.1 .V�.. b,
JOB SITE 5 �4.�fi1� 's f�.�t AM
ADDRESS:
OWNER - CONTRACTOR/DESIGNER/ENGINEER
�t)• +. 5 � itr1 € '=�`1 �1is'likCi:F 355 BRISTOL Vii'. M.
LA QTJiNTA, CA 017, l C•,(JSTA. lk E A. CA 92026
f61.9)771-5525 (71.054f)-1-060. COL -9 3324
USE OF PERMIT MA*14K G N'../%�[,,ES ,S .�'ASSOC 7
1S.1 FAMILY fD.1+Vf LONG 13M C AS`f CHAP;WAN tkV&
LA CZl_F.RJ rA FAIRWAYS.
AN 3
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2,014.W SF
PCYRCWPA'! 10
138:00 SP .
0ARA0I3fC!J .U?0RT
4,94x00 .S
FX1`IMA } ED ACCIST OF CONS1; iZUt~'I' ON
169.21.2.40
PFIR SIT .FFI , SUA11`11lt1>1i`!Y
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1()1�0t�4?�4.39-3111 -
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t,�ttTV3T121dC'I'1C.? FEE
101-UCS-4JR-OW
$01.00
N18CHIWICA1, FEE
1101.000-421-000
$5130
k 1.t?t Ttilt:Ai F'1?h:.
101-000420.000
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$145.:5o
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1fl1-1}0�t-21-{)t30
$06.32,
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$2i).uE1
INI -KASTRUC'I'URErt"S,
2"25-000-443-319
ART IN PT3El1; I Ul-ACM FL STL1.713
-000.255.000
$170.53
Sl.. D-WCAL C0N .z.ZT;kt1-_310N1 ><1,:N:D PLAN CHECK, $5.89 SM
LESS 1a:RF-PAID FEtS $0.00
A_
RECENT DATE .» (!.' k BY DATE FINALED INSPECTOR
y
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
BLOCKMIALL APPROVALS 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::
Appliance's _
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) i
_.
v .ti
- J
ITY OF LA QUINTA
Of BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner FAIRWAYS LA QUINT
Contractor AYRES GROlfP
960-U83
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
. .50-365 GRAND TRAVERSE AVE
JOB ADDRESS
SFD LOT 25 PLAN 3
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK 06 ok�'—
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BiEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - AM
FIREPLACE
BOND BEAM
O.K. TO WRAP
GROUT 0 4' 0 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR t5!!tr_ ZE:
EXTERIOR LATH
POOL PRE PLASTER
!�O�gENCE & GATE
"SEWER)SEPTIC TANK
FINALS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
1/96 1 ..-.