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/,� LICENSED CONTRACTOR DECLARATION
j hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
,/Date Signature of Contract , r •/t ��i,
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.
(.) 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 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 -1,should become
subject to the workers' compensation erovisions of Se -6 -tion 3700 of ,the'Labor
Code, I shall forthwith comply'withrthose provisions / )
JDate: `::7— ? - rFL&Applicant
Warning: Failure to secure Workers' Comp5nsation coveragdfis unlawful and
shall subject an employer to criminal penAies 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.
BUILDING.PERMIT
DATE VALUATION $Ia't27.0) LOT
PERMIT # CONTROL #
TRACT
6848
JOB SITE APN
ADDRESS i,;.990 AVAQDAJERswRA 774464-604
OWNER CONTRACTOR / DESIGNER / ENGINEER
v
I VVI I3A`t' 'D 0CAPvt1-9 !X.N130C , ;�RlCrlt`d!,` itt ttFy ��3Rf:ii.
5389v AVF:INI`►.D)A:?tt sRIiUA ($475 BEkROS COUM'
I.A. QUINTLA. CA 02253 CA11-I1 OKAL CITY CA 922M
t� 760)327-272 ) CBJ,ft 3577
USE OF PERMIT
PLUMB
801-10 .ALBABNi3O , SEWER COWNTC7
VAt.fiAric N
44,7.00 I.5 -
"D 'D COST OF C"ONSTRUCTION
PLUMMINoI*:Fr_ SZ?lf ER. 10.1-00041 kW $3iJ.iNJ
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 auth&ize representatiyes-of this City to enter upon
thefabove-mentioned property for inspection purposes.
% RECEIPT
,1£iignature (Owner/Agent.) 14 ��-
t' -/.,Date i1i)
• ,x
SUB
-TOT.AL C(:):�1S'"TRUC°TION AND PLAN CHECIC'
LESS
DATE BY DATE FINALED INSPECTOR
,1,727.90
V.1411"
$0.00
Sal#.00
7�
• ,x
SUB
-TOT.AL C(:):�1S'"TRUC°TION AND PLAN CHECIC'
LESS
DATE BY DATE FINALED INSPECTOR
,1,727.90
V.1411"
$0.00
Sal#.00
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
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
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVA S
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage'Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
c
Final
Utility Notice (Perm)
COMMENTS:
FROM 6193217798
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TRI STAR
APR -2d-98 S:dS AM P.002
TRI --STAR CONSTRUCTION
P.O. BOX 542
CATHEDRAL CITY, CA. 92235
ph. (760)-321-.0898
fax.'(760) 321-7798
Date i 1-7— 3 1998
My Address . L) Y510 h'lrime/W
To: City"of LaQuinta
Building Dept.
Please be advised that Tri-Star Construction has replaced my yard
to my satisfaction and they are released of any further
responsibility,.
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RTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
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AND ALL APPLICABLE CODES
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`:NG & SAFETY DEPARTMENT
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ED FOR CONSTRUCTION
SUaIECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
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6iJ'l DI�1G & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES
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6iJ'l DI�1G & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABLE CODES