9708-045 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty otpe�jury 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. Dto
674074 B ii3ll99
✓Date ignature 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 thie,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.
V 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.
STATE F W i;"i09S%
(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 e wo kers' compensation proOsiions of Sec ion 3700 of the Labor
C , Code, all fo with comply with thoselprovlslons.
Date: Applicant t -
Warning: Failure to secure Workers' Compensaionlcoverrage 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 result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quirita, 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 bf 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 prope'�'for inspe n p poses. }
Signature (Owner/Agenf,, t Date 4 � 5
BUILDING PERMIT PERMIT, CONTROL#
57,n
DATE VALUATION S169.5" LOT 44 TRACT 23
ld�
JOB SITe 911# `*U T M ANA
APN 6
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER ,
TD DESERT DFV LTD FA
%PARKS C4N:%TRLICn0N
PO BOX 719
79293 RANCHO LA QUINMA DR.
LA O. KrA CA 92253
LA QUINTA CA 92253
(160)771.1941 CRU 2996
USE OF PERMIT
SFD
WD .1►-04HANA PLAN VI -4. ART LN KU.W FLALMSi CkWiT OF
1171.41 tPER Aclrth ar',l dWr w/ CUM. DKV. 1x7('1•. PLAN i.7RiC K 1•M
11Mi('ED BY 7.911* FCllt MULTIPLE ISSUE OF SAM PLAN TYPE.
0,15TOM CONST UCMON 024.00 3 I
GARAG&CARPORT %V.00 8
ESTiMAT1ED COST OF IC ONSTRMION
16:,560.211f
PKR,Mi f i RIK RUMMARV
CON`SfRtk:'Flolm IFI& 1014X10-418- UU SNI.W.r
P1. AN (`FWV FFF 10140"W -AIR ' %17744
%. W,IAN1r7AL T=- 101.000 --?31 000 x51.3@
FA.ix'IIUCAL E -till 101-000420-000 X1217.83
PIXMBINCi FF7l 1014X}-419-100 $136.0
."*0WO n,Nz't'1(7N F1+ - R"V) 1014M14141(W) tIF ?A
ORAD1Nt:, FTI', 101.000-423.000 SM -00
R* kAS1'RIlC1'URE:Ffk 225-00"21-342 U791W
AWI' IN PUBLIC PLA:V.4 - 1Xtu*M 7014XIU-255-0 5171.41
ART IN PIWA,IC P1.A('FR - RF31r. 701 -04?%% -OM -S1?I 40
i
Si IR-l"TA.I. �'f1NS7 1-".0N NND p1,AN ('I MCK
St 3�1f 6%
PAID LESS PRETAID FEES
4171.40
AUG 2 8 1997 10TAL PKRMiT PEGS 0119 NOMN
SSJ*7.23
CALU F LA QUINTA it
RECEIPT
DATE
B
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
_ _
U
Ducts
Return Air
Steel
Combustion Air
Roof Deck
- Q —
Exhaust Fans
O.K to Wrap
— (/L
F.A.U.
Framing
Compressor
Insulation
2
'Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
p�
Final
Final
BLOCKWALL APPROVALS
StedG
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
tr
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
ki,
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) pj
COMMENTS: