0005-355 (PLBG)+ , L310ENSED CONTRACTOR DECLARATION
I 1--4,5y aff A 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 Eta 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.
z ,
( )' 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 1'+"1tEIe4CYNT COMP 90 Policy No. SM -1 10994409
(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 otf Section 3700 of the Labor
Code, I shal forthwith comply with those provisions.,^
Date:. ' le h f Applicant ri_
�--- —•
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, 6
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. insppectlon(purposes.
Signature (Owner/Agent)' ~ `"d Date
BUILDING PERMIT PERMITN
DATE VALUATION LOT _- TRACT t `
t U 9=50 229 26152
JOB SITE "* T APN
ADDRESS 8-940 VIA FLOXMICUR
OWNER ICONTRACTOR / DESIGNER /ENGINEER t
C I ANAOAY els CCUPANY
17480E 1?'Ci .a Yi. M 06
TUITnu
USE OF PERMIT
PY UMBING
C ANADAY & COZiIlPANY
17-480 _ 1 TTS i ST 0.106
CA 92780 17-191w, CA 92780
C114)508-4440 C1 % 0 4485
GAS L111,19 FOR 0B(.Z 8 LM (POK C0NNZCT1UTd TO 1-1%ATFD FUEL
V,y,L i.ATION
$00,0012
:E YMUM 1;? COST OT+ CONSTR%XM10K W.W
Pmd T.T FW auWARY
PId1U13INO FEE 101-000-419.000 S18,E0
SM -TOTAL C010TRUCTIONAND PLAN C1-MCKI $18.00
LESS PRE -PAID 1 s - .$0.00
r0TAL PF - If FEES DUE .[SOW
RECEIPT DATE/"" f o� BY { /, ATE WAILED IINSPECTOR
INSPECTION RECORD
OPERATION DATE INSPECTOR
BUILDING APPROVALS
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
. Combustion Air
Roof Deck
Exhaust Fans
OX 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
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:
.. C ity .ot La Quinta '. ;. } 1�1a
.
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Building a Safety Division
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- 14'
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'• ' - - P.O. Box 1504, .' I . .. . -
+
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+ 78-495 Calle Tampico , -1.r
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, La Qdinca, CA`92253
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Building Permit Application and Tracking Sheet • ' � . ' V t
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NOTE.• AD✓UST£D PER
LOT LINE AD✓USTMENT.
55.32'
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loc
STORM DRAIN
EASEMENT
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SCALE. 1'20'
RE IDENCE R
THS ORES
z
L/KING ARA 2443.0 .S F.
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GARAGE A A 636.0 S.F.
of
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m 3"
FF -59.90
PAD: 59.40
00
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17
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CONCRETE
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D w
5'
5
_
R=581.50'
r ,
L=95.87' EX. CATCH BASIN
'
— —I -LLORENC s
,
_JOB. ADDRESS
. .
IIIA` FLORENCE t
LAND
1910 S. ARCHIBALD AVE„ STE. N
LAKE -LA OUINTA, LA
OUINTA,
CA -V- ®E"tiELOPMENT
DESIGN
ONTARIO, CA 91761.
(909) 930-1466
S
CORPORA TION
FAX (909) 930-1468
_
DATE:
PLANNING • CIV1L !SURVEYING
r
SCALE:
SHEET:
J03 NV.
'
06/?4/99
LOT 229 •
S