0202-006 (BLCK)N
N_ W
O M
W
o Z
O O
JV�
IW— a
to
Z
M
LO
N
O rn
U Q
Il —
Z
rQCr0
LL
0 J J
mUU
O
d o`3i`
't Z
ob Z)
t` O
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,'dnd-my UL ense is in full force and effect.
License # Lia Class' ---14_11 Exp. Date
793988 C61 D031, ' 41(IfP2 ,•
Date'�� Signature of Contractor !� -
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.
)� 1 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 STATIF laUM Policy No. 373-101-0064301
(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 Jhe workers' compensation provisions.of Section 3700 of the LPor
Code, I shaw
ll forthwith comply with those,proslons.
,,,Dat it t�44_ Applicant X� . • � ^.-,.....
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety"
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the.. -building
construction, and hereby authorize -representatives of this Cityyto enter upon
the above-mentioned property fotinspection purposes.
Signature (Owner/Agent _. Date,
•`
BUILDING PERMIT PERMITlt
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS
APN
'PIS-I.IQ CAL.i,eRFSTADO
OWNER
CONTRACTOR/DESIGNER/ENGINEER
3 RO%1' HARE. (C -MOB UMT. UR"i)
: UHLAIM SCR'r''L.N MI) AW1.%F 1 G
.76-, �I� ?< MIJO
80.661 .A.r^.�.WD-2 C°"!'.
�i=4'(:,% 92253
IRD-10 CA W201
(€i5$)5fi22QE1 t.;'I3iE 4996
USE OF PERMIT ,
APPRC` VEE) B Y' STAN
69A iL? 42" ,fAL�q't�;jfC�1INU1�M{f
1y�yLy{R,
y1yikilyi.,t}Nt��7yM�'sdXZe APLANS
,,,A 8A'�,4.�1iIM'Ui'I F F.;�S'. FIJOE'I3A�;efY.1 Dr;iPA1!t MLrWi.
VAW AXION 1,10
i
EgrIA/KA" D COST O;r CONMUC11110H
CONSTRUCTION ?FIE 101 -!D0 418,x000 :'s s Ai I
!4
e 1c y�
. 4J lA.i%I `VS`./i.ej.F*i�.�d,i'.CZA�`.cJ.�.O,LIf�'1} 1•�i.ot�J.�V vZ'3.�J4L1i �'
'•i-.. ..1... 't'•Y.ii .i
�
' FEB 01 2002 m rnwirrimJs Dies now
t•a•t'1.°I"
.fay
CITYAFLAQUIR'iTA
r it
RECEIPT
DATE
BY` :
D E
INSPECTOR
r �J
1 — (
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Stgel
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 8 Controls
Party Wall Insulation
Condensate Lines
Part;Wall Firewall
-
Exteribr Lath
Drywdll - 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 C
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
3 EASY STEPS
SECUTRE POST3C1711AILS
ID IN GU,S
W.i T
Refer to out detEifed installation gu.de ror more information.
• � ILKINE I LjjJL9JM ���
CDMPONENT SYSTEM - LOW MAINTENANCE o POWDER COATED FINISH
• GLASS PANES - ALL ALUMINUM CONST--IUCTION - STR:)NG AND DURABLE
AVAILABLE IN THREE STYLES AND 5 COLORS
SL61-.TLY
4" o"
� lY
AP
3 EASY STEPS
SECUTRE POST3C1711AILS
ID IN GU,S
W.i T
Refer to out detEifed installation gu.de ror more information.
• � ILKINE I LjjJL9JM ���
CDMPONENT SYSTEM - LOW MAINTENANCE o POWDER COATED FINISH
• GLASS PANES - ALL ALUMINUM CONST--IUCTION - STR:)NG AND DURABLE
AVAILABLE IN THREE STYLES AND 5 COLORS
SL61-.TLY
4
pip
j1
2 ,• .,. KNE
FEATURES AND ADVANTAGES
• Heavy Duty ALUMINUM Construction • Increases The Value Of Your Hone
• Modular Component System • Shades And Prote.--ts Your Deck
• Durable RAILCOATTM Finish • Long Lasting Beauty
• Quick And Easy Installation • Affordably Priced
• Optional Skylights • Custom Sizes 4
• 5 Available Trim Colors Available
rk-
• Quality Craftmanship Ai s
AVAILABLE AT:
4A
i
a �
dl � J* /�/i (7 )-1 f.Enlc,C
C� 205 �z�STO�ANTi`
t o Gwd-1-1�-
3
S`
jDj
40<,T by
wot V
C,4 (tt S i '9 D ei
of-elc,5 G0Py
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE--
/ 0Z- BY
1.
Approved by* Date
0 Planning Commission
\ 0 City Council �-
`H] Community Dev. Dept. z¢=
Initials h LA-
Case. No.
Exhibit
0 With Conditions —.. -
OL- 4211 til�ti W*iltv.14
ci✓ouvta o�kLf- A✓eOL.
axf