9608-066 (RPL)LICENSED CONTRACTOR DEC_L'ARATION
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 #. Lic. Class , Exp.'Date ,
Date ��? Signature of Contra';`
OWNER-BUILDER,DECLARAT ION
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 withwages 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). °
O l.am exempt under Section , B&P.C: for•this reason
.Date r- 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 issueduMyN*kers'. compensation insurancecaVrier:r&,policy no. are:
Carrier 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' corn ensation laws of California,, and agree that if I should become
subject to the workers' compensationoprovisions of Section 3700 of' the Labor
Code, I s I orthwith comply with t ose provision,
Date:
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 he 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.voidA
it. work is not commenced'witNin 180 days from date of issuance of,Such
.:,,.permit, or cessation of work for 180'days will subject permit to.cancellatiori.
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.
Signature. (Owner/Agent) - ADate 7 /`. '�•
BUILDING PERMIT PERMIT# 96411,066CONTRO3884
DATE i�l i�11r1 VALUATION'' $13,4110, 0 LOT' TRACT -.
JOB SITE 4%�%� ��J•V..iMI N
AP N
.D1
ADDRESS
{
OWNER
CONTRACTOR /`DEpSIGNE`R / ENGINEER
7•yA �.
A ` ryy p y p
. ,': E; 00DS GIN 4.0! 11, 1 UlCrT0,14 -
19
SAN 88-RANID.0 CA 9244$
CAi'T't-11s.1"iI2- L CrIN' CA X2734
(011.9`024-1.7 2. r CiiL# 1044
USE OF PERMIT
r
Sa t�1>at�`>r'�sV Cep; O1+ ZN`'..uC'tO,t
Pi,. XX<,3'4 CK PVT $9:1_Fi0
C{ti j.1SIM111CITIOh' FM 1144.0:0
14 UC:. AN,I-+: AL Vu,_ ,PJOLIG3:1.•�.,Gd)
CO- - .fucAL t^rsrss,-- _d-t;;at;+:i:, 1.01 ualf)li-4At1-{3{){.i
11,umema . s 10I *41.9
'-.•7..rJ" ,'_
='.qq311..s•aiii• l'�°n"17. .:r �,I.�.5�'Lr-`el� .l';rC7� ..1vI1..IV.f/-�.^.p�y l ?ya.k�.^✓� I,Vr �000
n n .LA"N; ~T1SC*
ry rt l
L 3SS PRE_�PATD Res
so,00
DKCALPERNIffFEWSQUCT40W
s 5333.60
AUG
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
i..
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
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 e 76o,
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
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.
Smoke Detectors
Temp. Use of Power o
Final
Utility Notice (Perm)