9606-024 (BLCK)LICENSED CONTRACTOR_ DECLARATION.
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,
cle, and *my License is in full - force and effect.
'License # Lic:'Class ' Exp. Date
47,0669 1 7,
Date Signature of Contractor uA _,i J�;
OWNER -BUILDER DECLARATION .
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 With. wages as ' -tfi6ir's61e
compensation, will, do the work, and
d the.structure is not intended or offered for
sale (Sec. 7044; Business & Professionals Code).
1, as owner of the prope rkam, exclusively contracting' with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 1 am exempt under Section B&P.d. for this reason -
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty,bf perjury one of the, following'declarat ions:
I have and will maintain a certificate of consent to self -insure for.workers'
compensation,, as provided for by Section'370O."of *the Labor,Code, for the
performance of the work for which this'permit is issued.
I have and Will maintain workers' compensation insurance, asrequired by
Section 3700 of the Labor Code, for the performance -of the work fo . r which'this
permit is,js1sau�gqqlvll
,qworkers' compensation insurance Car,%&!
rie p I
,_.aicy.Ro. are:
Carrier Policy No.
(This section need no i t be completed if the permit val6ati6n 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
workbrs' compensation laws. of California, and agree that if I should become
me
subject to the workers' compensation provisions of Section. 3700 of the . -Labor
Code, I shall forthwith comply'with those provisions:
Date: Applicant.
Warning; Failure to secure Workers' Compensation, coverage is unlawful -and
shall subject an employer to criminal - penaities 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: hereby madelb-the Director 'o ' f Building 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.perso.n.at
whose reqOest and for whose benefit work is performed unde'r.6r Ouesuant'tb
any permit issued as . -a result of this-applicaton agrees to, & shall,Jndemn , ify -
& hold harmless the'Cit y'-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-.180days from'd A of issuance of.such
.permit, or cessationof 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 fo(,inspection purposes.
Signature (Owner—g—it)Date4
'BUILDING PERMIT PERMIT#9606-02.4
I
VALUATION
IT 5/1.6.
- - . , I . . . . . . TRACT ,.5.
DATE 6/ 9 $4 119 7
JOB SITE
ADDRESS 10 561SN"WhIONIACO
APN
OWNER,
CONTRACTOR/DESIGNER/ENGINEER
LANDAUDEV
IMPFRIA SkUN
L CQ�
P0.9ox I 172S
T.M4QUT'17Z CANYON 41.01.
PALM S11WING"N
PA[im, SPRINGS bA (Y'-7263
777 CBU 1787 - -
USE OF PERMIT
13.5 LIN 17T Or 5 FT. 6 IN 0W AND _54 V tfl; T. Qr- 4FT 61N Ow
4 ff. WALL. 5419) LF
5 F7V. WAL1.
ESTIMATED COST OF CONS'f RUMON
4,249.75
PKINA11,11 YEE SUMAIA114tv,
co
ZD
LAN
vn. 0
LIE P All F RE
IMAU E.
A
$72.
RECEIPT
]
DATE
BY
1
DATE 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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills '
Fireplace T.O.
Fans & Controls
Party Wali 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 Pibg. 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
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)