0002-029 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am, licehsed,under -provisions -of
Chapter 9 (commencing with Section .7000) of Division 3 of the Business and
Professionals de,,and my License is in full forceand effect.
License # Lic. Class Exp., Date*
OWN'
Dat Signature of Contractor
OWNER -BUILDER -DECLARATION
RATION.
I hereby affirm under penalty ofperjury that I am,exempt from t " he, tractor'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 thb, structure isnot intended or offered for
sale (Sec. 7044,,Business & Professionals Code).
1, as owner of. the property, am exclusively contracting with licensed
contractors to construct the project .(Sec. 7044, Business.& Pr'ofessionals
Code).
( ),,I am exempt under Section B&P.C. for this reason
Date Sig natur6 of. Owne'r t
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of.perjury one of'the following declarations:
ilFma certificate O I have and W ':intain�a of consent to,self-insure for workers'
compensation,.,is)provid6d.'for bySection 3700 of,the Lab6"r 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 dode,'for -the performance, of the work for which this
permit is issued. My workers' compensatiorf, insurance carrier .& 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 pe . rformanc6'of the wbrk'forvuhic'h t1iis'permit is issued,
I shall not employ any p6rSon in any manner so to become subject to the
s. I
workers' compensation laws of California,Nd tgree that if,l should become
subject to the workeis' compensation provisions,of Section 3700 -of the -Labor.
Code, I shak,fodhwith comply with t Se,p'rovisions.
Date: Applicant plic nt
)'I
Warning: Failure to secure �Vorkers_'Compensation coverage is.unlaWfp and
shall subject an employer.t6 criminal penalties and civil fines -up to $100,000, in
addition to the cost of comperisAtion, 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
ior-"a permit subject to; .tkii,;'con'ditions' 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 menced within liO cla`0 from. date of, issuance of such
permit, or cessation ation 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
cqrrect.,l agree to comply with all City,-.3nd State laws relating to the building.
construction, and hereby a6ihoriie—representatiVes of thig City -to enter upon
the above-mentioned property for inspection purposes.
DSignature (Owner/Agen/t.)-��
PERMIT#
BUILDING PERIVIIT.�..
J.
DATE' -VALUATION .1,7.jf) LOT 41), 'TRACT
2 93 W
JOB SITE -'IN
ADDRESS 48-577 VISIAVAL01k; 0
APN
64,p_166-066
OWNER
CONTRACTOR/DESIGNER/ENGINEER
T .0 ES ER:f 0.1-f NT L 0 P N1EN N 17PAR.
x S
'NTADR.
PO BOX I i6.
19-295 RdVqCi4.b.LA QU11
LA 0 1TVA, CA 92253
C! A, 9�1
L.A IC,)UWT'AZ 5
(.f60)771-19_41
C 29%
MU1 - 7
USE OF PERMIT
S_240L6'.RA�vflL`i DWELLING
Xt-'D.-LOT 49 PLAN M! - PEAWFDOES NUI P NCLUDE BLO(X UPALL CA
P00L, 75%.PLAN 0H.F_CKFFE. REDUMIGN FCft ISSUANCE gr!
SANE PLAN TYPE,
CUST oil 11 WNISIrSUIX-1 ON, SF
3,805.00 SF�
.693.00 8F
W
Er STT RIATE'D C0.8", ,gyp CONIS" V 'T
A, Vb a A %AL
e OR N a. J J MA M 'A K
(70NISWUCT1014 FEG
V
PLUM1311-40 FEE 0 0
ME n, 0 N1
X'Kc T, 3
DFW'LOPSR�
-W(* IWPUB PJIM-M 3 RFSW 71)'-000-255-000
A'L,10
AND PLAN
LESS TPRE-PMD.F1.E-
$0.00
-,170TAI, IJFRM;,-f YKES DUENOW
S'4J'i7..97-
RECEIPT.
DATEBY
DATE FINALED
INSPECTOR
�J-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set BacksUnderground
��
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof DeckZ
Exhaust Fans
O.K. to Wrap
yg�
F.A.U.
Framing
J
Compressor
Insulation_�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
I
Drywall - Int. Lath
/
Final
��
Final
_
_ _
POO
-SPAS
BLOCKWA
PROVALS
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
f�
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
-0000,
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
a