0006-135 (BLCK)TT _
LICENSED CONTRACTOR DECLARATION ' .
' I hereby affirm. under, penalty of,perjury that 1;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
t �.t Signature of.Coniractoe
t J
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 toconstruct the projecty(Sec. 7044, Business' &'Professionals
Code). ..
O 1 am exempt under Section ',. B&P.C. for this''reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
rLS
I hereby affirm: under- penalty of perjury one.of,the -following declarations:
O I have and mill 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 requiredby
Section 3700 of the Labor'Code,.for the performance of the -'work for which this
permit Js issued.'My workers'compensation' insurance carrier.& policy no. are:
Came. -Policy No:
Came.- - F REMQNT COUP ills � v . � 9P5U 179
(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 hall forth6ithlcomply with those provisions.
Date: I Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal:penalties and civil fines up to si00,000, 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 -6 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 & eachperson-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 8' shall, indemnify -
& hold harmless the City'of La Quinta; ritS 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,`arid-State.,laws'relating to the building
construction, and hereby authorize representatives, of ,this City to enter upon
iheAbove-mentioned property for�inspection purposes
1 1:
nature (Owner/Agent) L " ±` Date'
BUILDING PERMIT PERMIT"
VIA.Yb^�J
DATE VALUATION �c sd (�ryp �/� LOT } ( TRACT
!'� $4 YS� .00 1 \J� ' 26152 r
JOB SITE
APN
ADD ESS 78_915 VLil< Fl.C.F'o, t'`.p '
OWNER
CONTRACTOR / DESIGNER / EN INFER
t„'A.l ADAY & C OIv1P'A1` Y
CALMADAY & C ONOAN Y'
•:
1570 k3R.00MOL Low muz aunt los
1 sits:ffA00xH0_(1WW DRM* RIM, 206
SANTA ANA. CA. 92705
SANT.A.01A CA 92703
`
(?14)751.9151 '
USE OF PERMIT
Cf1��. �31:.lSI.�Tti'C3
'
160 LF @ 6' 131QH, 33 LF. 4' H1CfH 0A1ti.1; EN WALL d CIRCO
STANDARD
0 71f. WAL I i 160.00 LF
4 FT.'�i',F><LL 3160 Lre
mm) Cow OF CO1V•kC'.1RUC-7,d41vi.
-may .ry'y y q�y�^p� � y1�S.A'11
PErOA 1. 8� .t1..61. SUM" - ..
.
C;OV487RUCTION FEE I01.0C1f 438.00,30 $7.2.00
A
{
WLYB'-�'C,YYM,� C ONS*z�AMMION AND PI -AIT CHECK
�r a
�"7L<Ot�
IYUS PR.L -PA1.D FETEN
$0.'0 ► .
Z AL PMWr 61� rrci
~�2.c
RECEIPT
DATE BN'
rufw
DATE FINALED'
INSPECTOR . .
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
3 csv
Main Drain
Bond Beam
2w
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
Appliances
Final
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)
COMMENTS:
,