9601-137 (SATT)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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.
G7407v 13 :�'" if97
License # r , � Lic. Class i'"1 Expr.Date _ ..,..�
Date Signature of Contractor
OWNER -BUILDER DECLARATION t
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason:
( ) 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals Code).
() I am exempt under Section B&P.C. for this reason
Date 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 issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section gad� n t.b completed if the permit valuation, is.fo $00.00 or less).
() I ceitifk attinte performance of the work for whichft�i�is�`pe mit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to th'e workers' compensation provisions of ion 3700 of the Labor
Code, I shall forthv� ith comply with thosens.
X/}pr - isio
Date: 0 ,/ 4, /7Aonlicant j , - f I
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. hereby 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 fesult of this Plicc�llion/agr - s to, & shall, indemnify
& hold harmless the City.,,. -Indian- Its '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 180 days from date of issuanceof 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 authorize representatives of this City to enter upon - the
above-mentioned property for inspection purposes
Signature (Owner/Agent) !� -�. Date2l 11K1; ,
ALC MF.::::. BUILDING PERMIT PERM'T'
DATE IM17/96 VALUATION $146,190.70 LOT 2 TRACT 27835
JOB SITE ADDRESS APN
44-110 VI A V A.LL AiltTA 649-390-002
�+.q ` y't +y, �7.i 7y S_NI RKSy iCONSTeti£1y^C���r+pIC3�y��r.•.�..
i..O.I? SERrf3ilStI'..i��ii�.rY9f:.��fi L 101 ivr�i.tr.J�l�liR . iiJ.i�dPf38�A11`O..
14.0. BOX.* 1.7.1 Ll1l Qua" CA 01253
LA QUINTA CA 921.53 CBL# 2996
(61:0)771-1941 DESIGNERIENGINEER
i' tom"AREK-CRA.NDE L. INC.
USE OF Pmm LINC'IL.% .E:A�41L.Y ,,Vl' ,t\CF11:D 2367213IRT(WR DR.
RANCHOLA;I)UINTA
CASI'I'A§1.%T.P .F_1,' PL AN A I
FEE DESCRIPTION FEES
PORCINPATIO 200.00 SF
C;Al2A0rJCJUU10RT 467.00 SF
SU.L.-TOTAL CON STRUMON A.N PL.EAN.CI•IECK
LESS PRE -PAID PEES
D a TOTAL, PERAM' FEES DUE NO
146;590.70
$5,,205,55
:0.00
ss,205.55
RECEIPT I DATE IBV (DATE FINALED I INSPECTOR I
t
ESTIMATED COST OF CONSTRUCTION
PERM",' 1!♦ ICE NETtNUM ARY
K AN C RE GX .1.1.7,
101-f.100-433 i1 Pr
$664.29
CO'N3T1tU CTIC3N FFM-
101 -WO -4.18-000
$804.00
- WRICRANICAI: RSE
10 1 -04o-421-(30()
568.50
FLEC71RICA1.FEE
101-000420-4)010
420-4)01o�
;si3s:
1�1 e1 fli ilill?c;
001-000
101"000^41.9.0V V
.
-STONG MOTION kT-1? - RES.0
100-000.241�0()0
$14.62
GItADING FFE
101-000.4?3-006
$20.00.
INFT4..AS°t'R(JCrFURE'FEF'
225-000-443-342
$3,229,44'
.SRT IN PIJBL"IC PLACES - F.ESM 701--000-.2.55-000
•1
VISAS
SU.L.-TOTAL CON STRUMON A.N PL.EAN.CI•IECK
LESS PRE -PAID PEES
D a TOTAL, PERAM' FEES DUE NO
146;590.70
$5,,205,55
:0.00
ss,205.55
RECEIPT I DATE IBV (DATE FINALED I 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
BLOCKWALL APPROVALS
POOLS - SPAS
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
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)
COMMENTS:
llqq
,l a 7- P lt-
a
s _ s CITY OF LA QUINTA
hero,. BUILDING & SAFETY DEPARTMENT
43,�iTA 777-7012
' - INSPECTION REQUEST LINE
7
FE916`I 77-7153
� -DESERT DEVELOPMENT
PARKS CONSTRUCTION
Contractor 9601-137
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS
SFA PLAN A
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS B E"IGJNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SI NED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST 427
HEATING & VENT - A/C
FIREPLACE
ROOF !
BOND BEAM
O.K. TO WRAP -
GROUT ❑ 4' ❑ 8'
FRAMING C
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
FENCE & GATE
SEW R SEPTIC TANK
FI
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUS'- NUMBERS
JOB COMPLETED
TEMP, POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1,95 TURN ON UTILITIES OR OCCUPY BUILDING