0303-103 (AR)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 # y Lic. Class 'Ex Date
6IQit.�?�t B. FnC1�_7 17i3I/0,q�w•
Date Signature of Contractor ✓
OWNER -BUILDER DECLAMt ON
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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). r '
() 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:
O 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 -bp
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 STATE FUND Policy No. 046-1318-20114 .
(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 California1, and agree -that if I should become
subject to P.e workers' compensation provtisi �s�of Section 9700 of thyLabor .
Code, I shall for comply with those provisions.
Date:t't,/1�-1 1) 1 Applicar �
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 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 repfesentatives of this City to enter upon
the above-mentioned prope;If r inspection purposes t
,,Signature .(Owner/Agent) —""'-" =----_ Date'1`•` ", Ir�j
BUILDING PERMIT.'' PERMIT#
DATE VALUATION T, J, ewao LOT. is t TRACT 292
'Ll —
e
JOB SITE
ADDRESS 49-415 VL4 CO1VQUIS ADOIt
APN _
OWNER
CONTRACTOR/DESIGNER/EN (NEER
'13)DESERT x71_vF1>UP1wD.FNT
SPAS C014.71RUC.tic7.1d
i PO BO; 1716 -
79.295 RANCHO LA QiUWA DR,
LA MJF MTA CA :�22�3
� QUTt�TA Cha 22255
USE OF PERMIT
_R'E=M aTf&Aii}2M0N
SU11.Y11b349k4TP.L T'rU !''L:RAIT 90411.11ujv, H1iiL) A�LLf J V Poi(JTL1A • I
GUEST4 OLfRFMcI WITIAL CON'
CUSTOM CONSTRUCTION .47,00 3F...
WAM C0S-r ' F Ct?HS;[RUC'r10A'�3
29,446.20
•gyp yg7��p` y�y ,�w yA �7 X./ yM.�
dk C,.9ilY f �.� F. 9I P..f.6iYA.171IZ
CaNSTRUCTIO ME .101 -000-.48 9.284.50
t'
PLA14 CHEK' rEp, sr4i=p�10�d39-01£11 82�Y.Ff3
MWIiANICAL FELT 1131.000-421.000 .$39.50
ELF.CTMCAL FEE ..101-000-420-000
PL0.1AA131KO'.M£. , 101,,!000-419.000 �R.410
STRONG .R9®'.1014 FELY 'RE UD' 101.0600-241 -ODO
ART IN P'L BLTC pthCF.S - RE.11L 270.0017.444.5.000 M. .61 '
e 81,113-1 OTAL TTCC`"1"it)1q AND Pl(.W. (',F=K
7 03' PRE-PIUD 11
MOO
APR• 0 7.2003 . IXEM14-ff RMS D17. NOW,
DEPT• LA �UINTA ;
CITY OF
FINANCE
RECEIPT
DATE1
DATE FINALE4
INSPECTOR
l
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
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
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
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
7"
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit'
Rough Wiring -
Low Voltage Wiring
Fixtures
Main Service fl
Sub Panels ,
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power .
Final N
Utility Notice (Perm)
COMMENTS: