9902-144 (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
C14 , W ' Professionals Code, and my License is in full force and effect.
O ,=) M License # Lic. Class Exp. Date
LO
w>9t`ki4s 13 i+ifii0�3
o.Z �at' e _ '' /•% F Signature of Contractor
—
r--
J P'6 ' • OWNER -BUILDER DECLARATION
JUJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z ( ). 1, 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
r Code).
() I am exempt under Section B&P.C. for this reason
ul
N Date . ` Signature of Owner
0.C\1
U Q WORKER'S COMPENSATION DECLARATION
O Z I hereby affirm under penalty of perjury one of the following declarations:
'r.: Z 0 O 1 have and will maintain a certificate of consent to self -insure for workers'
X WrLIL y compensation, as provided for by Section 3700 of the Labor Code, for the
0 J Q performance of the work for which this permit is issued.
C0 Q U W I have and will maintain workers' compensation insurance, as required by
O,.U:Q Section 3700 of the Labor Code, for the performance of the work for which this
�.` Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
CO 0 3-vkn Imwr: W'15-31;»1230
g (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 provision's of ection 3700 of the Labor
3 Co, d, 1 shall.foithwith comply with those provisi W s.. -
Date: ��d�' Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit, subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or•cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
Construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) / -d/ F Date •••t /�'�''
BUILDING PERMIT PERMIT
9902-144
DATE (� VALUATION S1.9 J,7C)4." LOT I TRACTJOB
71 1 �7
ADDRESS :50-+C 6 �.RAi� O � Rt�'i` % �.��, f��'Ia��. E
APN 769-.650-008
OWNER
CONTRACTOR / DESIGNER / ENGINEER
I% 1^t` Lif91t.1CC i C !'3
Itd.l, lltlt 'd 6..61 t,r l.rl,r
1) L'T V114 1 A-11"CAS fo ".!
.t�J 1 !!! ! },�.,rf Aa/t/tY 1Nr et ll..
P.O..i x 1:10
14-25 E, UNIV R.OY F:eltlV."ti
LA QUI.NTA l3A. 9 253
P1411JENIX AY, 85034
f60"'o25?-il�S�i rAY,A 49911
,
OFPERMIT
USE OF
I�;llIX r MiL tiYELIJG.
'
L!,017 3L PLANA aFU P1:RMiT DOES NOT INCILM8.0LOC` K w'AU
QR POOL. F( R, AEt-I.1l."t'1PLE ISSUANCE OF
S.`b$.}) 9'CaTil.&I CN1"'1rTI X ��3
PORWUML04.00 9d'
0ARA0H/(,'tlRP0.tt'[• .56€0) 8
EN d sINWAl ti D CMT OF 1...' INS K311J'6,. a. 4i/ I!1
.19 S., 7Ki+tl'.a .9
REE SUMIL`11"Y
CONSTRUCTION FF -6 401-UtJ0418-000 $975.'uJ
:PJ AN (IFE K } 1914NUO-419-3 i
inti C"HAM Tj13a 5'93,50 .
FLECTrWCALC,. 9 E 101-000420•00 S150,94
P4.�i�2134MC}:I<i~✓i 10.4-000419-000 $156.$0
:
STRONG .Al 07 T ON FIT. - RE1810 01-000-241-WIO
GRADING -478E 101-CIO0423-OW
1'N RA.8TFCUCrit3'ti3 FEE, 22-5-000-443-342 E4,364.61
AWr IN 1PURIAC PLACCES - RE 311:701-000-25„'"DO
,SUP-113MAL CIONT"!t XTION NNi) M. PN CTtE(-:i:
LESS PRE ->?A D FEES
TOT&I, , PEidltti'!4fT Y' E, 9 8, 0014,' N•QW
$6,224.78
RECEIPT
DATE C G.' i
BY i �}
DATE FINALED
INSPECTOR
d •/ f
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
(�,G
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
tr-
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) .: - LL_
COMMENTS: