9609-047 (SFD)LICENSED CONTRACTOR DECLARATION,
"1 hei6eby affirm unddr p0halty of 06rjUry"that I am licensed under provisions of
,!Chapter 9 (commencing. with Section 7.000) of Division 3 of the Business and'
Professionals Code, and my'Li'c'ense is in full force and effect.
License #•
Lic. ClasseEx?. Date
Date Signaiure'of Contra6tor 7
OWNgR=BUILDER DECLARATION
I hereby affirm Under penalty of perjury erjury that l.am, exempt from the Contractor's
License Law for the following reason: 7
1, as owner of the property; or my, employees with wqg`66 as. their. sole
compensation, will do the work, and the structure is not intended or offered. for -
sale (Sec. 7044, Business & Professionals
ofessionalg Code). -
1. as Owner of,the property, am exclusively contracting �ith licensed
contractors
ctors to construct the project (Sec. 7044,. Bus. , iness & Professionals
Code).
O I am exempt under Section B&P.C. for this reason
Date Signature '6f Owner
WORKER'S COMPENSATION DECLARATION
l*hereby affirm. under. penalty of perjury one, of the following declarations:
I have and will maintain a.cettificate of consent to self -insure for woek41s'
compensation, as 'Provided f6rt.by. -S66tion 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 are:
Carrier Policy No.
S1 I ATF F UNT)
(This section heed not be completed if the permit valuation is for $100.00.,o( lei6).
(.) I certify that -in the, performance of the work for which this.permit.is issued,
I shall not employ any-'pers.on in any manner so as to become',subject to, the
workers' compensationlaws of California,'and agree -that if I sko61d bec6me'.
subject to the workers' cornipensation"'provisions of Section 3700 of the�Lab6r
Code, I hall forthwith comply with those p
.Eqvisions.
Date: 'V j f t frApplicant—'
Warning: Failure to secure Workers' Compen.s6tion coverage is U ril.awfukand
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
ees.-
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
applrcatiom-,.,,,k-,,,,.
..1. Each person upon whos , 6 behalf this ap - plication is m6de'& each p,6rso*'n at
-whose request and for whose'benefitd under'or work is performe un er or pursuant to
any permit issued as a result of this ap - plicaton agrees.to, &shall,indemnify
A hold harmless the City of.La. Qu inta, its officers;
agents and employees.
2. Any permit issued ssued 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 1 -have read this application and state that the above information is
correct. I agree to`comply witti.all City, and.State laws ,relating to th.6 building
construction, and hereby authorize representatives of this City to; enter upon
the above-mentioried Propeirty,frr inspection py'rposepl.
..
Signature (Owner/Agrol"Mq ba'-te_1
PERMIT IF CONTROL#
r(b'SUILDING'PERMIT 9,609-447
.
4 07 3.
LOT T Ri
DATE 1 -._.VALUATION 411�, So. jz,.
J . OB SITE All -31
APN
ADDRESS.
;OWNER.
CONTRACTOR DESIGNER ENGINEER
.3 ;ii,_?'s
LA QU11"N r1'1 fJk,
tA 9U I KI'A,. CA, 4,1253.
LA. QUfNTA, CA. 92
C81,1.:.# n j
MCI -
USE OF PERMIT V
I AV R VC VAC-C."V r -A 41d""Vi
XJL01.JVK7AN A-kf 1N C'9XV)T QYF
f 'NT N1 X' V1 IqT
S532.95 ILIRAGREIRORI )YV11WMPJVKITyou swpw
666M 3r
c;k,.J.',TNIATV) C.O.Vf OF C(ITSTRUCTION
PKRART FEE 8VAIMARY
T to %M L ICK 10 1,0)0
CONSVVRU(;.',MN FEE 101 0(W 11R -000
ME',CHANICAL F138 10-1-OW424-00
N0
..GRADVNG 1,
FEE 22,$4*0443-.)42.. S6,00tim
OF,
ART IN (I've; 7,of
-'sUg-Tar.A.11 CONSTIZUCTICNq ANOPLAN CHIECK
I RECEIPTDAT
E
J..
BY
PA E FINALED
N EC
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR f
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A2 - 4
Underground Ducts
Forms &Footings
Ducts
Slab Grade l -
Return Air
Steel o
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 Wali 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 Pibg. Test
Final I I
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 fit-
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
r
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:
O�
CITY OF LA QUINTA
��a, ° BUILDING & SAFETY DEPARTMENT`
777-7012
INSPECTION REQUEST LINE
777-7153
Owner T.D. DESERT DEVELOPMENT
Contractor 'PARKS CONST
9609-047
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 79-005 VIA CARMEL
PLAN 2 SFD LOT 22 f w T G: `
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR - U
EXTERIOR LATH
POOL PRE PLASTER
tS�ENCE & GATE
SEW SEPTIC TANK v T
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING
TYPE OF INSPECTION
DATE
INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING \? ; ; �.,
r ` v (�,
L4
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
-
JOISTS & GIRDERS
ELECTRICAL 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
-12- 4-1-2
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
-2
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR - U
EXTERIOR LATH
POOL PRE PLASTER
tS�ENCE & GATE
SEW SEPTIC TANK v T
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING