0002-050 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am,licensed uhder_provisions of 1
Chapter 91'l(COMMencing with Section 7 000) of Division 3 of the Business and
Professionals Code, and my License is in full force and "effect.
Lice6ie # - Lic. Class Exp. Date.
674074 13
Date Signature of Co 2ractor._;
OWNERB I uiLDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contract6r's
License Law for the following reason: ". .. . I . f .
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).
1, as owner of.
' ,the prIS,amo property, aexclusively contracting with licensed
contractors,to construct the project,(Sec. 7044,J.Business- &, Professionals
Code).
O I am exempt under Section` B&P.C. for this reason.
Date Signature'of Owner
WORKER'S,COMPENSATION DECLARATION
.1 hereby affirm under penalty of perjury, one of the following declarations:
I have and will maintain a certificate of consent to self-insurb for workers'
4'
compensation.as,proVided, for by Section '3700 of the Labor Code,' . for the
performance of the work for which this permit is issued.
O .1 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,.,wprkers' compensation insurance carrier'& policy no. are:
Carrier —Policy No,
�IVE P�74D-
(This section need not becompleted if the permit,valuation is for.$100.00 or less):
'I certify that in the performanceof the work ior 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,,��pdzgree that if I should become
•Subject.to the workers' compensation proVisions of Section .3700.of-1 Labor
I fo
-Code I shal rfl6ith comply with those'provisions.
Da . t6:, k,//f Applicant 211
Warning: Failure to secure Worl<iBrs'-C6—rn`pensation coverage is.un4wful and
shall subject an emplo'er to criminal ' fines up to e100,000, in
y n penalties and civil
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, -
fora permit subject to.,.,the conditions and restrictions set forth on- his*
application.
1 Each perso , n,upon . whose behalf this application is I made & each perso6 at
whose request and for whose benef it Work is performed under or pursuant to
any permit issued as,aresult of this-applicaton agrees to, & shall, indemnify
C .
& hold harmless the ity.of La. Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becom es null and void if
work is. not commenced within 1,80 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 authorizerepresentatives of this City to enter upon
th6 above-mentioned propdrlt�`foi ion purposes.
Signature' (0wner/'4
PERMIT #
BUILDINGRERM
I
X E VALUATION 4426 491 .20 LOT -.10 TRACT3W
-.4,9
JOB SITEAPN
ADDRESS 48-554 V]2S'YA.PA1ZAUN0
�4649-404 -0-06
OWNER
CONTRACTOR/DESIGNER/ENGINEER - -
ti S"O. $,,Of
rN N r Q
J Jy. LOJAO
tic) WX 1716
79-295Pa%NCFf0LAQA1q11, I At q
LAQUINTA, CA 92253
'LA QjMrAtA &A synn&i z
(760)77141941 CL-ft t,7�,,w
USE OF PERMIT
RNGLF.; FAMILY DWE11'
ING
8FO-LO T,70 PLAN M 1-,PBFW.fT r40%Sk40T.1 BLOCKIWALL OR
1100L. 75Q1110 I-ILAN CHECK Y0E., RMUCTIONI fUk MULTIM8 !SSUANCE, OF
IAME PL &N'T Nrf'&
PORUVRATTO 5 UG Si.
i
QA1tAGVCAPJ10RT 69-100 1W
3T
112 C'W'OF
lie 710-1
CIUNI'Tf R1VQ1r1Vtd F"He 101 -000 -418 -ow $1,2103.00
11AN CIMCKFEEF, •$247,07
ScrHANtAl, FES S 00
E. I. i': C -C R I C A L F F.6 5205:52
PLUND-31NO2 'M
IRVRIOMO -MOP'"N F. _YR. "SP.)
FRE
MACT FER
$40129
StiWFULAL. CONGYRUC'fl 1VANT) NANCIfEC'
17 a-7
b.
00A.
10'CAII 14HAllf-'r VECISOGE NOW
11.97
RECEIPTDAT
E
BY J JDATE
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
7 _�
F.A.U.
Framing
_� —pZ>
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
POOL 9PAS
BLOCKWA
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
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
7
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 ':
Smoke Detectors
Temp. Use of Power
Final
(> filo pJ
Utility Notice (Perm)