9603-080 (SFD)LICENSED CONTRACTOR'DECLARATION
Cb Thereby affirm under penalty of perjury'thatl am licensed under provisions of
Chapter 9 (commencing with Section 7000) o!.,Dyision 3._of>the Business and
N 1w Professionals Code, and my License is in ful,force and effect.
O Z) M License # Lic. ass: Exp. Date
1° 613161 B
Z P� 1Date � 'i 4;ignature of Contractor
Or�-
to PM OWNER -BUILDER DECLARATION
Hd 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
cY) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
• O CV
Cn
d Q WORKER'S COMPENSATION DECLARATION
o cc 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 !-.� compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U (L) I have and will maintain workers' compensation insurance, as required by
p UQ Section 3700 of the Labor Code, for the performance of the work for which this
LO
H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
ro 5)
�a
Q (This, se --tion need not be completed if the permit valuation is for $100.00 or less).
J () I certify that in the performance of the work for t 5 thin s p it is issued,
I shall not employ any person in.�anny manner so a to become subject to the
workers' compensation laws of California, and. agr a that if I should become
3 subject to the workers' compensation provisions of ec ion 3700�of the Labor
Code, Lsh II fo hwiffh comply wit tho - p dvisions.
Date:—
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 pa plication and state that the above information is
correct. I agree to comply with all City, (and State laws relating to the building
construction, and herebty authorize representatives of this City to enter upon
the above mentioned pro�erty-foon urposes. '� ^}�- p
Signature (Owner/Agent) Date J " 7=1 4
BUILDING PERMIT*
#�
PERMIT # CONTRO�L/ 8,12
DATE ��VALUATION
� TRACT�Q-, P17AISC
JOB SITE
"'SS 5 25 GUN a U
APN 7"1-420
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
FAIRWAYS LA QMTrA
AYW GROUP
50-523 43RMD TR AVUU
353 BRISTOL Si. #A
LA QUIWA CA 922:51
C(MA MESA CA 92626
(6101771-5525
(714)540.6064 CBIA 5324
RAN% GONT.A M & ASSOC.
USE OF PERMIT
: IWIL F FANUL.Y OWH1.1,1140
13% FAST (11APMAN AVE..
As
LAQ 11NTAFAIRWAYS
PLAN 2R
i 91" V)M ("t)ii`3I }tlK"1'fUN Z424.00 8F
OARACRrARKAT 522.(x)
SF
ESTIMATED COST OF CONSTRUCTION
I"*&"
PERMIT FRY, SUMMARY
Pi1.4N (lffit x Ff£F 101 -004 -i39 -3(R
"".00
(7,(:)NXIMUCPTON tlM 101.000-418-000
5989, so
114113 110ltCAL FkM 101.000-421-000
3920)
FJ.Fk'M.'AL FEE 101-000-420-000
3152.78
Pt.11WIN10 FEF 101.400-4f o-tM
ST0114) NOTION M - RLSID 101-400.241-000
ORADINO FEE 101 -000 -42.t -QW
5200)
tNFRASTRUCTt n FEE 225.OfM)-4 _VW
$4,478.87
ART IN P109.1C PLAC .8 - RFgii' 7014OFii)-2555-M
324'7.bS
SURA UTAL C0NSI"1tUC"YI0N AND PLAN CHECK
$.6,970.96
LESS PRIG -PAID FEES
$0.00
TOTAL PERMii FEF..' DUE NOW
RECEI�T, (
DAA; ( ((
BY ��+
DATEFINALED
INSPECTOR
1
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
OX 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
BLOCKWALL 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 Piaster
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)_
CIT Y OF' LA QUINTA
GUII.J.)ING & SAFE FY DEPARTMENT
77-1t70 12
!NSPEOTION REQUEST LINE
777-7153
Owner ['A I IM AYS. I NTA
GRO(T
Contractor
Permit Nutrtl.*f
POST ON JOB IN CONSPICUOUS PLACE
INSPEC'rl�_)R Iy,,Ullz7'f M.�. APFI�,IUABLE SPACES
50-425 AVE
JOB ADDRESS.-----....--..--.—
SFI) LOT 22 1' I,A N '-) I �
T
TYPL �'.c INSPECT!0N I CAIT INSPI
FOUNDA N i SC -'FBA
FOOTING STLEL
N
DO NOT POUR CONCRETE U.',j'[*IL ALL ABOVE HAS BEEN SIGNED
CONCRETE �'LAEI
JOISTS & GIRDERS
ELECTRICAL GROUND WOR�
D.Z.-i �01' P &�C 15 TNC -E'- i-li.-U- t T -1-L. A L L A 6 0 V E 1-1 A S 6 E E N S I G N E 0
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
-L,!!jL,C
HEATING V;: �/c
FIREPLACE
F30OF
BOND H -A -NT' -
0 K. TO WRAP
GROUT -] 4' 71 8'
FRAMING
INSULATION
PRE -ROOF
CC V 6T N 0 WORK U NTI L A B OV�` HAS BEEN S IGNE 0
('iRYWAL'- iNTER;OR
Z,
EXTERFOF�L. T�
POOL PRE PLAS,rr;rq
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
i(�AL
PLUMBING
FINAL GAS
HEATING - A4
HOUSE NUMBERS
JOB COMPLEI'EL)
q -to —pf- 077-111-11,:--l�—
I
ABOVE A1111ROVA'-S ��O NOT INCLUDE RIGHTTO
!.196 TURN ON U';'JLITIE!3 OROCCUPY BUILDING