9906-135 (PLBG)LICENSED CONT RACTOR 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
C42 01/ 29/2(N
Signature of Contractor—/,J-,,,,-
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 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 dontracting 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.
L11 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 sectiofi0n'e1RcYnbReQ'bFn rNed if the permit valuation iXFo`r$1trd.W&bQrQeSS
( ) 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 th:'6ii�pfb—ViSton—s-,�.—
/ D te:.i. — 72*-.�59 Applicant—
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subjectan employerto 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 propierty for iD urposes.
�/Signature (Owner/Agent) Date
7
PERMIT#
BUILDING PERMIT
DATE VALUATION LOT 4;w.i3s TRACT
co. 2_-,4),,-
11
JOB SITE
APN
ADDRESS
ANV51144 TPIRFAII14"Ityr.g DR
OWNER
CONTRACTOR / DESIGNER ENGINEER
NIR/MRS jBENJAtv1fN ALVAREZ
ECONO SEWER SERVICE
53-940 EISENHOWER DR.
84035 CABAZON RD. INDIG. CA 92201
LA QLWrA CA 92253
PALM DESERT CA �r.261
(760)346-2.793 CBL# 2142
USE OF PERMIT
AEPTIC. ABANT)ON - SEWER CONNE�7rION - LOW -MOD PROJECT(99-04)
CONTRACT AMOUNT 1,555.00 LS
LSTIMATED COST OF LVNSTRtX1'10N
PER411T FEE SUMMARY
PLUMBING FEF -- SEWEER 101-000-4194)00
JUN 2 2 1999
Y
SLIB-TOTAL C0NS!T.KUC`f (ONJAND PLAN Cf1jCK
$30.00
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$30.00
AA �_l
RECEIPT
DATE
BY ' ')�
I DATE FINALED
JINSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATETINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Stab 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 Finaf
Waste Lines'
Heater Final
Water Piping
Plumbing Final
Plumbing Too Out.
Equipment Enclosure
Showef. Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection V 44f LAA,:Z-
Encapsulation
Gas Piping. -
Gas Test
Appliances 7 -7 -
Final
Final
Utility Notice (Gas) F 7 -
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtufes
Main Service
Sub Panels'
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Pse of Power
Final
,Utility Notice (Perm)_._
COMMENTS: