0002-194 (SFD)-, LICENSED CONTRACTOR DECLARATION
I h4reby 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, and my License is in full force and effect.
License # Lic. Class Exp.. Date
07-4074
Date „'� Signature of Contractor' f
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury 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 need not be completed if the permit valuation 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
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of S,'ection 3700 of the.Labor
Code,1 shall forthwith comply with those provisions:'
Dater f A;9cam Applicant f
Warning: Failure to secure Workers' Compensation coverage is unlawful an
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 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 within 180 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 authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) f=�t Date
BUILDING PERMIT PERM';;O�a�_>r��
DATE `e� VALUATION N243,79 40 LOT TRACT 75154
JOB SITE
ADDRESS 7s-�� 1 1'.rA f1LlY €1 `V 111.
7 644-3212-07
OWNER
CONTRACTOR / DES�.I..GNER / ENGINEER
Ali alraySEU3♦11:V.1,!AJIAjP,AI
rr.,,.rrc
ARvSr0M rTra`aP
IOAT
PO BOX 1116
79—i9i RukNC110 LI A QUtN'iA DR.
LA QUINTA CA 02253
LA Qi. IN -1-A (A. 9 253
USE OF PERMIT
yY� n t yy ��� �9
r7IA♦SIL F, i'�Ai1�1.11A !� W' fa�,.LJINO
S%70- LO T42" PLAX 4 - I W4TT DOES NOT INCLU` E :6LOCK SA VMS Ok
POOL. 7V,'f)1y! AN CHECK HIX? 12kt)LCC t'1:0Y FOR. t4iULTIP E .1SSUIUNC 6 (A
SAS, F; PIAN TYPE.
C US T Cbi111 Ct' NSr RUCTION c _W5.00 SF
1}+, RCI•DPAT IO 80.00 ST
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d%a r�'iA hM 4 Fir SnW&P A�.c wr/ffi 'Li.L 4-401ir�?�A 401i.4J Q...9r�./11 It
6.�5 f'e WWkV
C0N, 8T'KU(,,'CTC»i FEe 101-000-418-000 $1,038,M)
P1eAh*`:1T1'•_ hVO Sno(114W.-3119
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t 1 EC f`RICAL 0611, 101.-6013-42(D—f1i)G
01U? d8flNG �11<9 tOl-000-419-000
'F _,REM) 101^f3(Nl-241.0041 'est
U`i2Al >! fJ'C3 :G'.Gk 101 -000. 23- ID arii�..Ot!
I)M, 0.GM. ftkii?F1C T FEE SI,90 y .int
A-IZ1' .IN PUBLIC PLACES - REStC 1011-000.255-000 5284.45
SUR -'i i Ai, CON TR,iK710-N AND 1C�I[,ylAiN (7ffrr .
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Tc'TA.s.. PFRAUF FEWS:;1 Vf'. (YW
RECEIPT
DATE
By!..
I 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
O. K. to Wrap
_
— G+Z>
_
Exhaust Fans
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
0D e
+
Final t� f
Final cel
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 ; A—
Utility Notice (Perm) , O
COMMENTS:
TYPE OF. I
❑ REINFORCED.CONCRETE
❑ STRUCT. STEEL ASSEMBLY '
�° �Z/eX
INSPECTION
❑ POST TENSIONED CONCRETE' O ASPHALT +' t ❑ OT ER
PERFORMED �, •
t ❑ REINFORCED MASONRY
r
' ❑ FIRE PROOFING
, .f.
JOB LOCATION - ,f`y
REPORT SEQUENCE N0. •' -
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T-YPE OF STRUCTURE r !
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PERMIT NO.--- c r' ,r„
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37630 Medjool -Ave.
DAY OF WEEK
5F 1-).. 0 ®Ile N
Palm Desert CA 92211
MATERIAL DESCRIPTION 4'" - �}- � : w . �P, ^-
ARCHITECT "v -x •
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Office (760) 772-7192
ENGINEER -_ +
A L A N S "
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Fax, (760) 772-7193
INSPECTION GENERAL,,,�c f - _:,: _ SUB
t' DATE CONTRACTORS ' " CONTRACTOR'
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Pager (760) 776-3338', ;
T.
REGISTERED INSPECTOR'S
WEEKLY REPORT.
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F
TYPE OF. I
❑ REINFORCED.CONCRETE
❑ STRUCT. STEEL ASSEMBLY '
�° �Z/eX
INSPECTION
❑ POST TENSIONED CONCRETE' O ASPHALT +' t ❑ OT ER
PERFORMED �, •
t ❑ REINFORCED MASONRY
r
' ❑ FIRE PROOFING
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JOB LOCATION - ,f`y
REPORT SEQUENCE N0. •' -
T-YPE OF STRUCTURE r !
Yz �,��1' 4%L,
PERMIT NO.--- c r' ,r„
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DATE ..
DAY OF WEEK
5F 1-).. 0 ®Ile N
Y is o®
MATERIAL DESCRIPTION 4'" - �}- � : w . �P, ^-
ARCHITECT "v -x •
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IN ECTO 't
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HRS. CHARGED
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ENGINEER -_ +
ASSISTANTS.
HRS. CHARGED
INSPECTION GENERAL,,,�c f - _:,: _ SUB
t' DATE CONTRACTORS ' " CONTRACTOR'
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.•"' CONTINUED ON NEXT �v E
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PAGE - / OF
• t4 CERTIFICATION OF COMPLIANCE a i ! .' 1~
I HEREBY CERTIFY THAT I HAVE INSPECTED'TO'THE-BEST OF•MYY; �+ _. ,,, �• �++
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE , a ;F S GNATURE OF REGISTERE NSPECTOR v ,
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED ;�' " * `� �Q s. rL �� ��' —
' M1■ `PLANS.. SPECIFICATIONS. AND APPLICABLE* SECTIONS OF. THE
` GOVERNING BUILDING LAWS.a" 7 D&TE OF REPORT l REGISTER NUMBER y'
�'a 2r