0002-119 (SFD)* w4b)
LICENSED CONTRACTOR DECLARATION
I hereby affirm under,penalty of perjury that I am licensed under provisions of
Chapter. 9 (commencing with Section7000) of. Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License #'4 Lic. Class Exp., Date
0 13 4
7- �-t - - -
140.,4
0751
of C 1�ctor
Date /1&1—:'Signature ontra..
OWNER -BUILDER DECLARATION
I heieby affirm under penalty of perjury that I am, exempt from the Contra foes
Lic6hse Law for the following reason-,
A) 1,' 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).
1, as owner, of thii property, 'am exclusively contracting with licensed
contractors to 'construct , the project (Sec.' 7044,' "Business & Professionals
Code).
(VI am exempt under S4cti6n 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 certif idAte"of Consent t ' o self-insure.
for workers'
-.compensation, as provided for,by Section- 'j700 of the Labor Code; for the,.,
performance of the work for which this ipe6it -is issued.
( ) I have and -will maintain Workers' compensation insurance, a ' s required by
Section 3700 of the Labor Code, ,for the performance ofth6 work for which this
permit - is issued. My workers' compensation 'insurance carrier & policy n . o. are:
Carrier. Policy No.
�7
(This Section need'not be completed if,the perm.itvalb;ifation is for $100.00 or less).
(,),I certify that in the performance of the work for which this permit is issued,
+shall not employ any person in any In , arrh-e-r-1c, as to'become subject to the
,workers' com'pe
� niation laws of California, and) gree that if I should becorne
subject.to workers' compensation, provisions, of Sectieh,370,0 of the Labor
Code, I shall f fthwith coi�nply,with those proyi
ions
Date: L Applicant
WarningFailure to secure -Workers '.Compensation coverage Is 7unlawful and
shall subject an employer to criminal penalties and civil fines up to*$100,000, in
p
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'a011ication is made & each person at
whose request and for whose.b6nefit 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 be6omes hull and void if
work is not commenced -within 180 days from date of.issuance .of such
permit, or cessation of work.f6r 18d'days 'will subject permit to* cancellation.
certify that I have read this application Arid 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
N
the above-mentioned property for inspection purposes.
I. , signature - (uwner/Agent)—
BUILDING PERMIT PERMIT#4 01110241 .1.9
f-DITEVALUATIONRAC$22%1852,00 ;LOT, 4 T T
JOB SITE 48-5941 VISTA.CAWCO
APN
649404-0-19
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TY." DESERT kV,xLbNIMPT17
SPIN.I.LKIS CONT MN
PQ BOX 17116 1
1
79-293 RJVqC_H0 LA QUHIUADR.'
LA QLAVIA CA, 9?151.
LA QIJINTA Cjk, *()2253''
(7( )7714941 CB1_,# 1�%_
USE OF PERMIT
SINCELE F,"Iruy' DATL4,1NO
sFD _I.0T201PLANVSiRJ- PEJUMI.TZGES NOT IN, U UTJE,,RLCxi3KWALLS0
8 AA4F-,,RL AN TYPE. t..
PARAWCA"010,' 614-4Y0 V
EST INIATED COIST OF CONSTRUCTION
=111SIS2.0 ell
Pir,560T FE, E SU, MMARY
N C H E GK KUP -90
PLA _X8
f 4
%L — 21-000 ail. r1
PLUPOWNG FIRE .1014)00-41.9-.000
OE'trELOPET11 UvIVAC-T 038
/01-000-255-00
AXF W 1 UBUC,11LACIFS -RESkC'0
SUB-MTAI, CONMUMTONNAN Q FIGAN, CRECK
9 W
US& PftF_-PA.1D FIE S
•$0.00
410TALVER01 ITP "YRJE
PCES I -NOW ,
RECEIPTE
DAT
BY//
DATE FINALED
INSPECTOR
IN_
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
'10Underground
Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
„— —
Exhaust Fans
O.K. to Wrap
— pa
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
,_C
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 p
Utility Notice (Perm)
CQMMENTb ,