9603-079 (SFD)LICENSED CONTRACTOR DECLARATION
HI hereby affirm under penalty of perjury that I am licensed under provisions of
.Chapter 9 (commencing with Section 7000) of Division 3 of the6Business and
T, W Prafessionals Code, and my License is in full•force and:effect*"
C) Z) Ch License # Lic. Class Exp. Date
LO 613161 i3 f261�
IrZ Cr
0 Date _Signature of Contractor' t
OWNER -BUILDER DECLARATION
J U (0
Hd I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CO 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).
Cl) () I am exempt under Section ,. B&P.C. for this reason
U-)
N Date Signature of Owner
ON
C7
d Z WORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () I.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
mJ QJ performance of the work for which this permit is issued.
Q U ( ), I have and will maintain workers' compensation insurance, as required by
O U Q Se&ion 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
ob 5
r` p
J (This section need not be completed if the permit valuation is for $100.00 or less).
O I certify that in the performance. of.the.work for w,hich�this ,permit is issued,
I shall not employ any person�in any manner so is to become^subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions ofSection3700 of the Labor
Code, I shall forthwith comply with thosZtprpvisions.
Date: - r- Applicant N
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 l have read this' application and tate that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction; and hereby authorize representatives of this City to enter upon
the above-mentioned propei3y for inspecti'on.purp�oses.`
Signature (Owner/Agent)��s�-.\\-c.. [
ate
BUILDING PERMIT
PERMIT# °°NTR°`#
�� l,A�� f) 24
DATE 3/61-96 VALUATION .519411,91,40 LOT'
21. TRACT -1&)— I PI' • +'- y
JOB SITE 50445 CRAND ANIFI ISE
APN 769.64:,sE 0.5
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
;'A11:WAY: LA91
A°rI?t�S�'rItOI31'
50-525 2K G.1tAN1) "i 1fiU1 1v;:td SE
355 i31RISfOL ST, Al:
1.A.Q-A!INTA GA, 92253
COS"1.`A MFSA. CA 92620
(b1 177 - 32
(214)540-6064. 0111A 33.2,9
;RAND =NXALES AS4,50C.
USE OF PERMIT
SINGLE FAMILY laWIR1,1,iNO
!336 RAST C;HAPINIAN AVE.
046.3
1. A Qa::RNTA t -'AI WAh";
P1 -AN iy
C0.'0,*01kt C td3'CRUC-t'1t N :032.0 1411,
PORCHIPA110 186.00 SF
GARAONCA?2PORT 513,00
S17
kSTIM,ii CINS i' OF CONSTRUCTION
194,&1,44 ti
PERMITITTESUNIMARY
PT. A.t+FC:}x}10%, Fro t
A785.08
Pth 101-00'1-418.000
NIL,( III. CAll .. FE1,., 10111-000-421.-000
t°:1,1»t:3: K IC.AL P%i's '101 -01W -420-01W
�1'C.1NON M0,111061icUSH? 101-000-241-000
V9,42
Mt i3iNG 1+& J01 -OW -423 -ow
$20.00
INF'RAS'1'10)(�fURE, F111 225-f]tD0-143-342
54,30.55
,RFtT Int P1tfil,IC' P! A01-9,7010)0?_55-000
$235A8
SLJ,13-'T'+t TAL COWIRUCTION AND PLAN CHECK
G&O1
LE.S.S TRF -PAID R.ES
0.(N)
TOTAL :PE IMUT FEEN DUE iYOUr.74
6,01
RECEIPT.
DATE r
BY •
DATE FINALED
INSPECTOR
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
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
C ITY Oc LA QUINTA
-�AFF.Ty DEPARTMENT
BUILDING &
777-7012
INSPECTION REQUEST LINE
777-7153
Owner_ FA111WAYS L�A QUJIN]'A
AYI�ES (3ZOLI P
Contractor 7
Permit Nurroet
POST ON 108 IN CONSPICUOUS PLACE
INSPECTOR M!;:;'F S:(,.)N .-\LL. APPLICABLE. SPACES
-TRAVI"WSE AVE'
JOB ADI)F:FSS
SFD LOT21 Pl-k N 4
r 1�4�
DA'tE INSP.
FOUNDATION SETBA.-'�K
FOOTING STEEL
MAIN GROND SYSTE7A
GROUND PLUM-'31NG
PRE-GUNITE
DO NOT POUR CONCRETE UNTil. ALL ABOVE HAS BEEN SIGNED
CONCRETE 6
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
00 NOT POUR CONEFifrE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND
O.K. TO
GROUT (71 4, D 8
FRAMIN67_,_________"
INSULATION
PRE -ROOF
COVER NO WORK UN I*iL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR I
EXTEMOR LA'N-i
TER
POOL FIR LZS
POOL FENCE & GATE
SEWER SEVTFC TTANk
FINALS
ELECTRZAC J,
PLUMBING
FINAL GAS TEST
HEATING -,VC
HOUSE NUMBERS
JOB COMPLETED
E M F, FO �,,N E R
ABOVE APPROVALS 00 N01'INCLUDE RI0HT TO t
1/96 TURN ON UTIU:Tl(-,S . CR OCCUPY BUILDING I
L.0