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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 2&f the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
1;31 G480/21
Date ��' . j Signature of Contractors
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.
SUM FUND 1MR1,0
(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,P_ rovisions,-_ /,
Da Applicant
""'Waning: 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 City to enter upon
the above-mentioned property for inspection purposes.
jSignature (Owner/A ent) "=-^'' Date//�^�`•tl '
g4 BUILDING PERMIT PERMIT# .
DATE .1 /1VVALUATION LOT 01,06-1(g TRACT
JOB SITE i Q _ 9 ?O
APN
ADDRESS ( 1 /
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MI)MME 3r3HONI..Es
11,91
34007 MMAI, A 9`.l;rIMC, RE .1.2u'
E� ��/
�'/� [[���+►�rryy���(��1��,3fTTJ1��yS AVENUE
WO i/LINI�,AL TJ.71'd.�I VE:a G��rf,J,. 525
m1�".�ISWE, INA 92506
Rrff13Z...%TArDr CA .92.306
USE OF PERMIT
SHRIMIS UO ,ftU l;..9
S?,D - WT 701 PIAN 34-- PERMIT DOn INOT TiNCLUDE HLOCK WAU,
POOL OP. DRIVEWAY ,FaS'PRGy31-E:K 74%MUCTION TO PLAN CHECK FX9
AXPLI.ED FOR M.ULTIPIX SUBMITTAL OF SAMB PLAN TYPE - r
CUSTOM CONSTRUCTION 2386.00 SP
P011CWAT10 3".x.00 $?
041't.A£3.RiCA1 PORT (S1) J%584.00
I;':CD�'d' C4�,° �,`C�.�1�.�o:(x�9fO.t�'
.�:;3'�,?,3'"1k.�4�
y9g$•y/�y }'P e)g, �� yp ��p,,'IuiS'��
�yYid^6bY7�1.ffi/1 �Aip$L �.EJfG1.2'G.7& `'a•
CONSMUCTSt?N 'FE2 101.0010-41 B-000 $1,129.50
:PLAN C1•iN..X WE 101.000,439-318 $23(1.V
",X.. 101.000.411,000 $83,50
i�i.3!:MRICAL. F29 101-00",20-•000 $164.31
S'UJY! DINGFFIR 101-000-419-000 $18L73
STRQ141 MOVON FEE. - RPS1T3 101-000-241-000 $23.97
G", DINO RE 101 -000-420-000 -000 V0.00
11` FRASTRUC I°i3MP YU. 225•,000-443-34.2 $1,907.00
ARS' P4 PU314C PLACES .RME 703 -000-2$5.000 $139.28
8` 1Y)TAL CX01-POR CS1:1. COC10N Ai~iD 1+'Y.,AN' 101IRM
$3,941.68
1. 5 MaePA,,JD �'�13
$0.00
e
D
CAT,' � S1 x' SIXES DUE WOW
M41,68
AUG 16 2001.9,1
CITY OF LA QUINTA '
FINANCE DEPT. .
[F4jECEIPT DATE/, f yyy
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs CJ_G=� ��j
Underground Ducts
Forms & Footings
Ducts
_V(
Slab Grade i
Steel
Return Air
Combustion Air
Roof Deck �U �Z�J [ _
O.K. to Wrap( /
Exhaust Fans
F.A.U.
FramingI/��:3o-.��
Compressor
_
Insulation . 2� (f _
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
;' ewer Lateral
Sewer Connection ` 3� G�
Pool Cover
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. o
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
i
B IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-990 FRESA ST.
SFD - LOT 70, PLAN 2CR - PERMT DOES
NOT INCLUDE BLOCK WALL, FOOL OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL l
MAIN GROUND SYSTEM
GROUND PLUMBING —CJ
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLABQ- O'/ 0141
JOISTS & GIRDERS
DO NOT POUR CONCRETE UNTIL ALL ABOVE HA -S BEEN SIGNED
ITY OF LA QUINTA
UIL
ING & SAFETY DEPARTMENT
C
777-7012
civ
SPECTION REQUEST LINE
CFO.777-7153
-, g0
'
LD HOMES
aimLD
HOMES
106-104
B IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-990 FRESA ST.
SFD - LOT 70, PLAN 2CR - PERMT DOES
NOT INCLUDE BLOCK WALL, FOOL OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL l
MAIN GROUND SYSTEM
GROUND PLUMBING —CJ
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLABQ- O'/ 0141
JOISTS & GIRDERS
DO NOT POUR CONCRETE UNTIL ALL ABOVE HA -S BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
- c)'7
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT O 4' O 8'
FRAMING
Q
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR O
EXTERIOR LATH
POOL PRE PLASTER
L ENCE & GATE
AEWEA SEPTIC TANK O - O
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST — 2
HEATIN1 - A/C "
HOUSE NUMBERS
JOB COMPLETED "
TEMP POWER
ABOVE APPROVALS DON,OT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING