0002-112 (SFD)- '
LICENSED CONTRACTOR DECLARATION
| hereby affirm under penalty ofperjury that |omlicensed under provisions o/
Chapter 8(commencing with Section rooAiofDivision 8ofthe Business and
Professionals Code, and myLicense ivinfull force and effect.
License Lic. Class Exp. Date
~~~-T---*��--~'v''~`.'~..'~~'' .
. OVVNER'mu|LDERDECLAR/TlON
| hereby affirm under penalty of perjury` from the Contra tor's,
License Law for the following reason:
( .) 1, as owner of the pl�operty, or my employees with wages as their sole
compensation, will do the work, and the. structure is got intended oi�'off Bred for
sale (Sec. 7044, Business,& Professionals Code).
( )- 1, as owner of,the propertyi am exclusively. contracting with licensed
contractors to construct' the project (Sec: 7044, Business &.Prof essi6nalS
I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENS�4TibNDECLARATION
I hereby affirm 'under penalty of perjury one of the following de6laration§:
( ) | have and Will maintain a certificate of consent to self -insure for workers'
compensation, as,'provi��led for'b�.'Seiction 3700 of the Labor Code, for the
performance of the work for which this �ermit 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
workers'Perriiit is issued. My-'worke.rs' cortip6nsation. insurance carrier & policy no. are:
Car�ier Policy No. .
STNrE FUND :0-14' )�0007338,
(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,
.1 shall.not employ, any.person in any manner�so Tas to become subject to the
°,'and agree that if I should become
Subject to tl�e workers' compensatio�,provisions of �ection 3700
,'Code, U;ha, those provisions/
°Applicant—
Warning:
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 SectionN3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby rii,ade to tfie Directorof Building and Safety
for a permit subject to -the conditions and restrictions set forth on his
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
0` PERMIT#
BUILDING PERMIT 01101-1.12 1
DATE VALUATION S214%85Z-fXJ LOT 1.3 TRACT 29306
JOB SITE 48_48.5%ri5TACALiC0
APN 649L160_019
ADDRESS
OWNER
CONTRACTOR DESIGNER ENGINEER
1,10 BOX 117i 6
79-295 RANCHO LA Q!WWA DR.
LA QU QN'rA, CA 92,253
LA QUINTA CA 92253
USE OF PERMIT
SAW, PLAN TYPF,.
W. TIONT
PERMIT FEE.31IM-AURY
CVNS'rRU(* r1OX CES 101-000-418-0(Y0
JUCr IN i"USLIC PLACES -RESID 701-000-2 55-000
TOTAL
42
RECEjPT
DATE
DATE FINALED
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
0����j-8
F.A.U.
Framing r
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
YE
Party Wall Firewall
Exterior Lath
Drywall -Int, lath
Final
Final
—177,e
POOL - PAS
BLOCKWALL APIPROVALS
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:
_
O GC
Final
Utility Notice
_
L%%% �
pS
D41 LOQ, �o� �7-•� c)
-
(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)