9902-147 (SFD)LICENSED CONTRACTOR DECLARATION
U I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N w Professionals Code, and my License is in full force and effect.
O =,) ,M ' License # Lic. Class Exp. Date
a 690645 B 6/30/00
oZ r—ate 14 Signature of Contractor
(D 0' f
J U ( OWNER -BUILDER DECLARATION
WWW r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL CL 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). _
*`} ce) () I am exempt under Section B&P.C. for this reason
J:.N
Date Signature of Owner
Orn
U Q " WORKER'S COMPENSATION DECLARATION
o 2 X1 hereby affirm under penalty of perjury one of the following declarations:
LinO (.) -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
m.J' Q performance of the work for which this permit is issued.
Q_ C)(y�)) I have and will maintain workers' compensation insurance, as required by
Q. V ' Section 3700 of the Labor Code, for the performance of the work for which this
d Lo'
>H permit is issued. My workers' compensation insurance carrier & policy no. are:
:Z
Carrier. Policy No.
�:.
<� (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 California, and agree that if I should become
subject to the workers' compensation provisigas of Section 3700 of the Labor
1 Code l shall'forthwith comply with those fovlslons.
Dete. '?
^'��+ f�� Applicant _000Warning: 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 avid 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 above information is
corract. 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 property for inspection purposes. ,!
Signature (Owner/Agent) Date '7+�
.V
BUILDING PERMIT PERMIT990214*7
DATE VALUATION 5195,764 9;) LOT 34 TRACT L 99-3
JOB SITE
ADDRESS 50-605 GRANI)*]'Ii Vr,.R*,J , ikN' 1,,,:NIIJE
APN 6.9-0so-o3 ."
OWNER
CONTRACTOR/DESIGNER/ENGINEER
P.O.-BOX $10
1415 E_ UNIVERSfrV DIU'VE
LA QUN'I- A. CA 02253
PHOENIX A% 8SO34
(h(ngr- >i. e, CA_Lf- 4990
USE OF PERMIT `
SINGLE FAMILY 1J1A ELl, NG
i.OT M ,ALAN 2AR.. SED - PEWIT .1X)i;S N0T .Q4C rJJJM .�Lf1i" d� VIxZT�i .fi
OX I100L. KAN E flL,.CEN.FRERMYCW) FOR 1N113:G'i'WLE ISSCf.ANCE OF
SAM(; PLAN TYPE.
CU.5'I o'M COANTSMUC'TION 103.4 i.00 Sr
1'iaR4:11 PAT10 .134,(H) SI^
E4.Af.:.A(i11:j�'C7IC'.I' $f►.4..i1f;+ �;.h'
ESTIMATED Y ED CONT OF \.Y T,'18TRWC 1GN
1"T. q 64.90
ji :�yy ;;��,y �s y �• �;� 7'�[ �,.jy ,j
COINS':(•RUCTIO1V H.143 101-000-418-000 &4t79._�tE
P_1,ANQTr,0K F56
a" `1 ru, •i illi -M-1121-000 $93.56
11LE.C3UH11N. Fec 101-000-420,000 SI -44),94
PI.iEMBING FEVw IO.I-C (4-41 =12U0 $11361y.)
%
{-TROrTi+A C:)'fge lvi h ;-:4i'w:.�.`m 1f11, CiOti-"r:3( fiCtil 549,148
ORAD,wc; Vmx. 101,000-423.000 S^;CCf.00
Ildl'.ltf��l•LRk�4"i`lllC9.ii'.ESG :��a�,-�3�t-���a.��'ji f 1.�ftiFl,+a!
AIVE IA4I?q BLIC .PLA-C'ES $239,41
C{)6A(L`3"RIK 110N AN[:.1 PLAN t ITEC K
SiSy�^Jd.'li�
LE&S PRE-PAWFEES
$0.00
10TA L PERMlY CECS "L UE, NOW
S6,224.78
RECEIPT / +
DATE f� „
BY / /�+
DATE FINALED
INSPECTOR
J_) lL: ' J
INSPECTION RECORD
OPERATION
DATE .
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
. Underground Ducts
Forms & Footings
44
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U. -
Framing
- 6 -
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
ALO -
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final -
Utility Notice (Perm) 5 -
COMMENTS: