0106-106 (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.
License # Lic. Class Exp. Date
Date /v�'�p Signature of Contractor''----
R-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.
(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: r�'//. /ir.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 ;
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 cancellatioh.
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.
Signature_(.Owner/Agent)--'-�
BUILDING PERMIT PERMT#
DATE VALUATION LOT TRACT
2' 9139JUM 72
JOB SITE
ADDRESS
19-994NNISA Sl.
7w720-023
OWNER
CONTRACTOR / DESIGNER / EN (NEER
STM"f'IC�LD ElOWri 2I.M.
11D Howe's
3400 C'1'N�?1'iAL AN3D40 Me, 325
.3400 (MIM EiAL AVEIRTE 3 Me „ 25
S;!'i�'.MIDE OA 42506
'1 NERSM G CA 92506
(909V)6i2a53 Z CMA 5386
USE OF PERMIT
9119F. IELD HOWS
SiNGI F FAM,'9
3400 CENTRAL .t VF74UZ S'T,E 325
;4FI) - LA#'I" 4 PLAN 28R-, PERMIT D09S, NOT 1NCI,L DF. til, C.Z WALL,
PCK)L O,R .I7YUV ,Wd'AY .AV4',IR OCH. '7`S% IY.LTaUC'I ION TO P).,Ax CHECK FEF:
.&PPIAED Y!X) x MUL1IPLE St1BblITT.AL. OF rJiIlCI? PLAX T'§ M
CUSTOM COi1MUC TI.014 7,aSo'.0t) i,F
1
PORC'I•IIRATIO 174.00 SY
(;" t.c4MI ARPO'RY QW) 1.1%3$4,174
HIMMAM. COST OF C;CbMM'67t'"7"L.. 014
2',9, 732.rm
CCINSTPUC: Y'1OW .FM M-000-416-000- $1,129,50
Pt,AN C;Hiwr., n, F,10 t �C+Ot1 'E3 -3 Y $2 if).:t7
Ar1IIMAXICAL. PER 101-000-421-000
EUC1'1I.ICA1,M 101-= -420-000
20.000 E7ftd.31
PLVDIXa o FP.1*. 101-000.419-000 5151.73
S"PRONCI MOTION M, r RESID 101-000--241-000 0--241-000 $33.97
0RADINO pep, 101-!,000-410-000 8"A
41SPRAS7i'iilJC7`flRvit . 225.-000-443-342 $5,907.00
`F RA PUBLIC 1*LACI • FL98IC 7€11-000.255-000 $99,28
..Y
t NaT9?UCTION AND PLAN elWICX
$3,941.68
LESS M-PY=
D
$0.00
AUG 16 2001 PF.RMT ;N ME NOW
$3,641
cm, OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE
ATE FINALED
INSPECTOR
..s
e-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
�Q _ _ _
1 �Q eDucts
Underground Ducts
Slab Grade
��( ir
Return Air
Steel
Combustion Air
Roof Deck
/G .2 3– �%)
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
.Exterior Lath
Drywall - int. Lath
Final
Final
I
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
/_ `
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral _ /
�0—C1�'``
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
i
' a ITY OF LA OUINTA
�c DING & SAFETY DEPARTMENT
N
CFO
m-7012
C.0 g SPECTION REQUEST LINE
a c� O R 777-7153
LD HOMES
Cont F LD HOMES
Permit Number 106-106
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-994 ERESA ST.
JOB ADDRESS
SSD -SOT 72, PL
.AN 2$R - PERMT DOES
NOT INCLUDE BLOCK WALL, POOL OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK - S —d /'A—
rw I m%a a I rrt. IL
MAIN GROUND SYSTEM I
PRE-GUNITE I I
DO NOT POUR CONCRETE UNTIL LL ABOVE HAS S ENAWN§D
CONCRETE SLAB d
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
_v
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH GAS & GAS TEST -
HEATING & VENT- A/C
BOND BEAM
O.K. TO WRAP - O
GROUT '0 4' O 8'
FRAMING I/ f4�!e
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR - M d. /
A60VE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING