9611-029 (BLCK)_
LICENSED CONTRACTOR DECLARATION
| hereby affirm under penalty of perjury that |omlicensed under provisions of
1-- Chapter (commencing with Section 7000) of Division 3 of the Business and
U)
m uu Professionals Code, and myLicense ioinfull force and effect.
C,) License # '`-an.o/a�s Exp. Date
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4P W804
CD 0) — -- J\
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OVVNER'BU|LosRDECLAR4T|Omv '
uu LU | hereby affirm under penalty ofperjury that |mnexempt from the Contractor's
' �� License Law for the following reason:
Z ( ) |.onowner of the property, o,myemployees with wages aotheir sole
compensation, will dothe work, and the structure ionot intended o,offered for
sale (Soo.ro44.Business uProfessionals Couo).
( ) |, as owner o/ the property, am oxo|voivo|y contracting with noonoou
contractors to construct the pvNom (Soo. 7044. Business & pmfoxoiona|o
Cod*). '
<>|amexempt under Section smPC.for this reason
LO_�________
m Date Signature of Owner.
cn .
WORKER'S COMPENSATION DECLARATION
o 2| hereby �,m undo, penalty of perjury one of mo following declarations'
m'�"- ()| have and will maintain acertificate ofconsent mself-insure for workers'
Y= uomponoauion, as provided for by Section 3700 of the Labor Code, for the
{]�� pohn,man000,mowom�,which miopermit ioissued.
ou �� 0 (Y) | have and will maintain workers' compensation inoumnoo, as required by
Cj C)G��on 3700 of the Labor Code, for the performance of the wm,x for which thisoL - permit is issued. My workers' compensation inav�n000amo,u policy no. are:
It Z _ Carrier &T4713 FUND Policy No. 1496'0w6 29^
ob �n
< (This section neednmh000mplotednmopennxvaluamon isfor $1oO.0Omleoo
( ) | certify that inthe performance o/the work for which this permit |oissued,
| shall not employ any person many manner v000tobecome subject mthe
workers' compensation laws ofCalifornia, and agree that if| should become
subjecttthe workers' compensation i |on of Section 37000fthe Labor ^
Code, I shall forthwith comply with thos0provision S.
Warning: Failure to secure W , Orkers' Compens tion coverage is unlawful and.
shall subject an employer to criminal penalties and civil fines up to $1.00,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
|Mponr4mr Application mnw,ouymade mthe Director ofBuilding and Safety
,o, a permit subject to the conditions and mumouonv ov� m�x on hisapplication. '
1.Each person upon whose behalf this application ia!made meach pomun,�
~~
whose mquomand for whose benefit work iopenonneuunder o,pursuant to
any permit issued uaoresult mthis appnovxonagrees to, & shall, indemnify
u hold harmless the City mLuQvin:a. its officers, agents and omn|ovoo�
o. Any permit *ooueuaooneouuo,minoppovaxionbecomes nunand void if
work is not oommonuou within 180 days from date of issuance o/ such
pormu, or cessation oxwork for 180 days will subject permit tocancellation.
| certify that | have read this application and state that the above information io
correct. | agree tocomply with all City, and State laws relating tothe building
oonstmction, and hereby authorize representatives o,this City to enter upon
the bb"e'monuonou property for inspection _
| J�gnaxune �xwnowgonV oo�����~���
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DATE
psnwITw
oowrnoL#
BUILDING PERMIT
961,14129 �0 ������
°�"�«���
JOB SITE APN
ADDRESS 477,535 NIA MOINT IGO
OWNER CONTRACTOR / DESIGNER ENGINEER
VS0 .p
41-535 VIA.'WOW117100. 66675 PANOFU�KIAAOAD
LA QUiNTA - 92253 CKFHEINIALCYrY CA 922M,
CK'N 350
OF PERMIT
3@��.�G�lD�S�VV�I�^��<�)��A.
101'0N0°#R~0M �h�V
LESS PRE-PA-10,PEES'
By
RECEIPT DATE DATE FINALED INSPECTOR
--r�
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
Firep%ice 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 APPROVA S.-
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
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
Final
Utility Notice (Perm)
JLL-01-19% 16:51 FROM MAINIERO. SMITH B ASSOC. TO 5645204 P.02
PLOT PLAN _ .
LOT 255 - .VIA MONTEGO
QUESSA. ON LAKE LA QUINTA
CITY OF LA QUWA ,
BUILDING1-
DEPARTS
J ALLY
CCE ®�.CON
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T TO TBON PER
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AP Lft LE C0MS,
2 5 DATE 2• �3Y
m
MODIFIED s
PLAN 3
.25
SCALE 1" = 20'
t
_
TOTAL P.02