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LICENSED CONTRACTOR DECLARATION
I 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
6337232
Date J Signature of Conti�actor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, as owner of the property, or my employees with wages as their soie
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).
( )' I am exempt under Section B&P.C. for this reason
Date Signat.ure of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury 6ne 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 6f the Labor Code, for the
perfor Tance of the work for which this permit is issued. I
(VI 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.
ROYAL RNS. CO. OF i VIV 4 59.01,
(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 provisions of.Section 3700 of the Labor
Code, I shall forthwith comply with those provisi6ra
Date: _1_-__/-_2_�-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 aind.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 fro * m 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) Date,/-- �6_
PERMIT #
-BUILDING PERMIT
!�007-192
D LUATION LOT TRACT
AVIAN 0 6 2006A 79601-1
JOB SITE
ADDRESS 79-4"i) OESERT VVILL(AV S-1 UET
APN
649_03&02ii
OWNER
CONTRACTOR / DESIGNER ENGINEER
CAiTULUS RES111DENMA11 C01%,11401M.M.Es.
DIV CjXl,r 1,4 F fe V� ESI DE NIIIAT, r.:v
gj�,
_5 PARK PLAZA, S-OrM 403
3 PARK PLAYA SU171 400
M
IKVINE CA 926t4
I KV IN E CA 9�6 14
USE OF PERMIT
SINGLE PAMiLY D-WFLUNG
&F D - LOT 85..KAN 3 P=WT DOES 140-C rNCLU!7)E BLOCK WALL OR
POOL_ 6% PLAN CHECK WAXJC1'10NAPPL!k'A) �'Olk &1ULTwL1-_-
T CW
Z R. J kc r C STRLUCTIGN 2,0,97.00 Sr,
KjRCaPAT10 124.00 8F
0ARAGOCARPORT 450.Uo SF
11 1 �
-rs,f INTAIM."D COST OF (VINISTIRUCTION,
124,336.30
PEWMIT FEE, SWAMARV
C0NSTKTC1'T0N FEER 1.01-000418-000 S727.00
. AJ
PI.AW (-jTF(-IC �Ff 104 -060-439-3 18
CIA-vOTHICAL F U i i0l-W042"00
PLUMBINU HE 101-000-419-000 $160.00
-RE Mst) 10 1 -OOn-241 -C100 S11141
0 ft A 1) 12N .0 1 ?M` 1,01-000-423-000 Vnoo
.06'110,Uf LIC VLAC ,S -.RFS10 70 i -000-255-0(W
LWV0.0PH,R IMPAU17,FEE
Sf TIR-T(YrAf, CONSTRIX110N A�Nn PT-AN'CHECK
VA"?,46 i#,i
LIESS RIRJEFTAW FEV"s
MOO
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD.
OPERATION
DATE
I INSPECTOR
OPERATION
I DATE
I INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Z_
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
J/
Framing
,y
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
ol
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_Z__.9 -9-
Final
2—
Final
BLOCKWALL APPROVALS
Steel
POOLS-SPAS
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
Water Piping
Aq
Heater Final
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
—A S -
Gas Test
2 2 - z_
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) -3 - 7-,) - Z_
COMMENTS: