0106-105 (SFD)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.
v --License # Lic. Class Exp. Date
Date J"=' .7;%%�� Signature of Contractor
ER -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 F
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
j () 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.
j(_).-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.
C (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 provisions.
Date:e`i.�/•.� 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:,,:.
I 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
s & 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 buildings
construction, and hereby authorize representatives of this City to enter upon,, r
the above-mentioned property for inspection purposes. ;
Irl^��........y... �� % F...
Signature (Owner/Agent) �_f - T•^ � """ Date''-�'h' ! I*,
BUILDING PERMIT PERMIT#
DATE / VALUATION LOT 0106_105 TRACT
JOB SITE ` �"
ADDRESS
APN
' r
75K -M FI: OA Sr.
769k A-0",
OWNER
CONTRACTOR/DESIGNER/EN (NEER
SXaUMELD 3 LOWS
8E;tWtE.M ROWS
RWERMDE. CA 92306
RWER IDE CA 92506
(909'')682-5352 C3��.=44, 5386
USE OF PERMIT
SI'IEF'i{tdILD HOlt+M
MMIETAMMYDWE.IGLING
3400 f.:i`2IVIA L "FENUZ SS i" .323
SFD o LOT 71, PL,.Ett,N3 3A.. !>,I"!NMIT DO93 NOT I.NCLU1;31I; I3WCK °. ALI,q
FOOL OR DRIVEWAY APPROACH. 7516 REDUCTION' TO PLAN C," RRC K FEE.
APPLIF11 F011, Ig9VVJP1R al,bSRJ ITTAL OF SAW" KAW `i`YP&
(AIS°POM CO14ST- ACT'ON 11102100 OF
PO RC HMATIO 300.00 i5F
uAukawCARPORT(SP) 12,4139.20
99nmTKl) COST OF COINS: UC11.17off
2M,121,00
PERMYS bIEE WWRY
Crl')Nii%'RUCTIO FwC 101-00043t: OOD $1,196,00
PLAN CHK'K FM 101-000.439-318 $AS.74
Iv1x;C"1WTICAY,FU 101.000-421.000 $93,30
F:LYXTIUZAlL�' 101-000-420 00 $171811
1•'1,,{.IgtlP11r1O FHR 103.000.419.00D SID100
riTRU.1�0MC TION FF -RMID 101 -000 -241 -OW $23.S)
ORAIDINO VE 103.0140.47.3-000 - $20.00
YNt`RA,!P,TR.UCTrURF, FM 225 -NO -4433-342 -342 SI,W7.04
ART F'1 BILIC I LAC UfilEn 701-000-251-000 $145.30
•a 1
U843 PIM -PAID
$0,00
AUG 16 2001 xI FER Mo DUE HOW
CITYOF:DEFT. QUINTA -�
ea
/
RECEIPT
DATE :';
'By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
�� •� j ,�
Underground Ducts
Forms & Footings
Slab Grade
Ducts
Return Air
Steel
Combustion Air
Roof Deck
_
l() aZ.2'O I
Exhaust Fans
O.K. to Wrap
T (/
F.A.U.
Framing
� `U (
Compressor
Insulation
_
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/ U
Drywall - Int. Lath
,Si�.ec.� wAr L
/O—t G- O ( �3
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
_ Q (ARX
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
/p
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Fina
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
.
Final
Utility Notice (Perm)
1 Y OF LA QUINTA
�I G & SAFETY DEPARTMENT
C= 777-7012
e.r I ECTION REQUEST LINE
C-0 g ju 777-7.153
"4
U. z
WSMSF D HOMESOwner
ContraD HOMES
-105
Permit
P CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-992 FRESA ST.
SFD - LOT 71, PLAN 3A - PERMIT DOES
NOT INCLUDE BLOCK WALL, POOL OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK - -
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING —Q
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB a(
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT UR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF Ad _IZ21Q►
BOND BEAM
O.K. TO WRAP - O
GROUT O 4' D 8'
FRAMING 2 d l
INSULATION
PRE -ROOF
COVER NO WORK UNTIL A QVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FINALS
ELECTRICAL !. Qz _ o
PLUMBING
FINAL GAS TEST — - 5 Z 7 -:,LL
1
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING