0106-108 (SFD)C14 I)
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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
•Chal%r 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 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.
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 ti ' 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 shgill forthwith comply with those_ provisions•>,,.�„�
Date: !46110 -len ► Applicant
Warning; Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer io criminal penaltiesnarid 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.
-3i nature (Owner/A ent)�-^'"�” Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01.06-108 TRACT
J
Iv) 273€7. 71111 +�.Bt�'�•'7
JOB SITE
APN
ADDRESS
1
754-",13 FRENA k" -T,
7619-720-024
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MITIML AVENUi .` '1`.C:: aV25
3400 CMT. `:FALL L AV`f AJF_ M325
l i xel X31± CA 92506
MRSIM CA 92506
(909),682-5352 VPAN- 5366
USE OF PERMIT
SHRIMILD g7C�1,111i
11�[b1. 1. Y1 bllMi t:§
3400 CENTPAL EMLIE STE W5
5
P� • LOT W, .VLAW 2AR • PERMIT 0OZS NOT E24CR.t INW. BLOCK WALi,
POOL R Dtti[VIMAYAP1;ROA:CK 75%UDUCTiLYN TO PLAN Gf.(ECK FEE
A)VIJED P`GA MULTIPLE SUB.MI TTAL F' %AW, PLAN TPF
C1S8MAI C'C3NFrR;111CT.1ON 2881100 air
PORC'•I3MXrio 320.00 S?
0A1tAWC,AMPORT (19) 10,584,0
k!.A'D1M COST OF �,`•C NSMI�'4':`.I�O
2_.0 9,712.60
(�ym�ty�,r� rpNFnr-yy:�,':�°!
��rr FRE
.141���Y Mt.+VE �s4/l:YJ.I. A .W
CCyMMUC"° ION, PEF101-000,418-000 $1,129,30
PLPPw CHWV1 K211 141-0004MM 1230.37
'%iI ILANIC.ALiMS 101-000421.000 salso
XLECTRICAL 020y, 101.000--420•-000 $164.31
PLUM•B 40rse 101-000.4.1.9.000 $1181.;15
ST:CS71! 0 a071ON 17. ,5 • RRS1x9 101-000-241-000 $33.57
Cllr 1133 t 101.00-0.42 -000
F1�°. s'LA1s"fi3p1:1C Lf i{f L 215-000-4.43-34.2 3-3 2 $1,W7.00
ART .iii PUBLIC PLACES ` 111���rL,YQ1�� 00f3r735y0t8i! $99,. 8
c�
PCE '°OMSIVRXICT3:tr`X AND PA.ndOT ai kyc
$30841 AS
AUG16 2001 'f O.w4'd.At daEF'.'. r .i,'SsERMAN Rv'I
taD9�!�>'roSa
CITY OF LA GUINTA 1
FINANCE DEPT
RECEIPT
DATE, f
BY: + °
DATE FINALED
INSPECTOR
/ =
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Ol �/ ��
Underground Ducts
Forms & Footings
// D���'"
Ducts
Slab 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
�2GI
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
Heater Final
Water Piping
//
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral/D
��
G V`pz
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. 1
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
3 O
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CITY OF LA QUINTA
`vo a aU LDING & SAFETY DEPARTMENT
777-7012
cl*4 0INSPECTION REQUEST LINE
5w 777-7153
U- x
Ow a CS IELD HOMES
Co tra or --�§H IELD HOMES
Per Its p 106-108
lz;��N-3013 IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-998 FRESA ST.
SFD - LOT 74, PLAN 2AR - PERMIT DOES
NOT INCLUDE BLOCK WALL, POOL OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS B EN -SIGNED
CONCRETE SLAB Q i
JOISTS & GIRDERS
ELE(;TRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF r✓ �/j
i BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING 0�
INSULATION _
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR ffL % C/ ( !%
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
E SEPTIC TANK (j
FINALS
ELECTRICAL21--,elil
PLUMBING r
FINAL GAS TEST - 2
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
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