0004-211 (PAT)LICENSED CONTRACTOR DECLARATION
filOereby affirm under penalty of perjury that I am licensed under provisions of
C,hapter 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
6996911. • . T)0 �1 52� Lf� A
1.2131 t'2(
ate � Signature of:Contfaeto lI %
OWNER DECLARATION
I hereby affirm under penalty.of perjury. that I am exempt from th'e'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
1. 1t')•U v BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0004-.21.1 TRACT '
760
JOB SITE APN
ADDRESS 52,400 W.3F_YYJ.0W.KR_ DME
OWNER CONTRACTOR / DESIGNER / EN (NEER
FRS ANK C UZISM
52.400 033ENH g'1 fiR1JRIVE:
LA QLINTA CAS. 92233
USE OF PERMIT
PAII0
9UNLAN D SCREW & AWWAG CO.
46080 CA1' NOUN S'dFJX1'
INDIO CA 92201
('760)347.0592 CBI.ft 4996
ALUMA.W000 WOOD PATIO COVER 72 SCS. FT. (1CH096o19)
Q WORKER'S COMPENSATION DECLARATION '
p 1 hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers' PORCWPATIO 7210015F
X WAW compensation, as provided for by Section 3700 of the Labor Code, for the
'O :�' Q performance of the work for which this permit is issued.
m .Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U QSection 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:
Carrier STA,Y'F: FUNIS Policy No. M-99.0006454 T STJ ATED d"(3bT OV CC+N9MMON 957.w
co. D
0'1�'�I' }i'I 6[7Afr(tyl�2t
J (This section need not be completed if the permit valuation is for $100.00 or less). P1,AN CHECK FER 10) -101(()0439.318 st $16.1615
( ) I certify that in the performance of the work for which this permit is issued, CONSTRUCTION FELE 101-000-4.16-000 x;5.00
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 l should become STRONG MOTION - RESID 101-000,1241.000 tso
1 subject to the workers' compensatio/provisions of Section��/J3700 of the Labor
•�•i7 ode; a sh I,forth:with comply withR ose r r ons. d✓
VDatet� " +"3 - i1 �*(plicant svc r r .7 a'•
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 SLT�'IU1ALt�zs7 t2ucc1 ANDP11" CI3 X41.75
any permit issued as a result of this applicaton agrees to, & shall, indemnify , LXSS PRPrPAID,'MMi $0.00
& 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 ' AIL � TERMVP I+"IM D1`T) NOW $41,75
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. "fl
&
I certify that I have read this application and state that the above information'i's «
correct. I agree to comply with all City, and State laws relating to the building
COpAtruction, and her fiy authorize representatives of this City to enter upon n
{ the above-mentione property for inspection purposes.
t / ¢�� RECEIPT DATE B/Y f > DATE FINALED INSPECTOR
Signature (Owm15r1A�gent J�d%� r "-1,41-�x1� Date
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. La
c404 -"e L1 zd t
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)
COMMENTS:
//
NAME �� fNN�C C. i�J �l S / e`L PHONE (
SITUS ADDRESS
ASSESSORS PARCEL NO.
Provide North Arrow
REAR PROPERTY LINE
TD ' pt To
4us ij
ir
V
a
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVEI D:..
FOR CONST .AU10 f4
DATeli4 BY�
1
FRONT
A RE -INSPECTION • EEE OF $30.
WILL.BE CHARGED IF THE APP E®' ,
PLANS AND 10B CARD ARE NOT ON
THE -SITE • FOR •: k SNEMUOI;
INSPECTION.
.NO EXCEFDOM. _
PERTY LINE
L
N
E
0)
iCREEN & AWNING
46060 CALHOUN ST,
STRE T Sa �°0 �/ s�4°a)�' _ 1ND10, CA 92201
(760) 547TO592 FAX 1760! 775,
�ouSE
i
._-- -- - �- - -�--SUNLAND SCREEN & AWNING CO
,
--- --- 46080 CALHOUN ST,
_--.INDIO, CA 92201
___-(760) 347.0592 - FAx (760) 775.5434
--CITY OF -L-A QUINTA- __ __ .__A_R£-INSPECTION_f.EE_:4F 130 . - --- -
--BUILDING-&-SAFETY-DEPT.- - - ; 1 .
WILL BE CHARGED IF THE APPROVED ;
+ APPROVED - PIANS AND-ANOARE-NOT-ON- �' --`� - -
_wFOR-- _ _--__.-THE- -SITE -FOR---A- SCHEDULED
CONSTRUCTION '
___-_INSPECTION.
DATE -BY
NO IXCEPTIONS!