0101-258 (BLDG)•� LICENSED CONTRACTOR DECLARATION
% 41 hereby 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
397169: 1 iu
Date)-' -01 Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l 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 soli;
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 theproject (Sec. 7044, Business & Professionals
Code).
O I am exempt under Section ; B&P.C. for this reason
Date Signature of Owner
Q WORKER'S COMPENSATION DECLARATION
Z I hereby affirm under penalty ojury one of the following declarations:
.. p fper() 1 have and will maintain a certificate of consent to self -insure for workers'
I compensation, as provided for by -Section 3700 of the Labor Code, for the
�
Q performance of the work for which this permit is issued.
C) ( )' 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
Hpermit is issued. My workers' compensation insurance carrier & policy, no. are:
r,Z Carrier. Policy No.
O STATE FUND' e#1.4122_0
Q (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 Section 3700 of the Labor
Code, I'shall forthwith comply with/those provisions.;
r Date: 1 '' R Applicant +k:M i La'14
i �—cam �
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, onhis
application. s >:
1. Each person upon whose behalf this application is made & each personate:'
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. t,
Signature (Owner/Agent) , '" aA: . AA^nkALN Date��� ;L
BUILDING PERMIT PERMIT#
DATE / _ VALUATION LOT 0101-2M TRACT �.
s est .
'JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INFER
" AASSBAUM
iumJt it�il :i d C1N 2Ui';fi�(`✓Pd iA �.
80-�4$0 � ,WA Q-TAUXP
4WP90 DaER1' "
LA. QUWA 92M 3
RANCHO WRAOIR, CA _92210
(7115 BP? 6� 146 Mfi x;16
USE OF PERMIT
i1WHERAL IKULDINts'.ii
16031, 1r. 611 C`}AibM W46,LL, "V L P. 4'H itA,f rJF'N IWALL A'
Del>,l'`PT—I GARDEN W- AU.; (POOL IOUIP VV CMW� )t - CITY.81'.Aw)AlPM
6 PT "WALY, I.,(103M 111
3 FT, WALL 10-00 LF
h !?T, WALL "A la'#F
\ri/'SS OCA 6n6J.LYG7yt.A5.�6J4+ry.�6ld,Y
yy y�y ,gip. �,t QNy. �p ��,`'•.X�.'+ni7�rA�Lr•1.GRCY3..CJCed/
R"2�ZL�d.H. X1 .�i.dZs C7&7d.LVA.AiBG.St
CONS TT'aIMI'1'1(: NFR'F;
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JAN 2 4 2001
IT ui� LA IluB
.N
RECEIPT
D
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"BYDAT
IN ED
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
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings 6�—
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
_
Final 1 4� — I
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:
i
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)
Dec 16 02 11:51a p.2.
k ' q tSb
s
CETT OF LA QUINTA
& SAFETY DEPARTMEf4T
777-7012 '
INSPECTION'REQUEST LINE
?77-7153
NUM NUSSBAUIVI:
Caner
Contractor RICK JOHNSON CONSTR17CTION.
Permit Number .0101-258 '
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALLAPPLICABLE SPACES
80-940 VISTA GALAPE.
JOB ADDRESS r
�• 1003 L.F. 61I1 GARDEN WALL & 37 L.F. 441 GARDEN WALL 8c
r I0L.F.5'H GARDEN WALL (P.00L EQUIP ENCLC SURE) - CITY
STANDARD
TYPE OF INSPECTION ' DATE INSP. '
FOUNDATION & SETBACK
FOOTING STEEL
Y
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE—GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED'
! CONCRETE SLAB' r
# JOISTS & GIRDERS
ELECTRICAL GROUND WORK"
r DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED'
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT—A/C
1 FIREPLACE
ROOF y
BOND BEAM
O.K. TO WRAP
GROUT. ' ❑ 4' - O 8' .:
.+
FRAMING',
INSULATION L,
PRE—ROOF i
Y : COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
' DRYWALL INTERIOR 1 r
4'
EXTERIOR LATH
f r POOL PRE PLASTER
POOL FENCE & GATE .
SEWER SEPTICTANK a .:
fINALS:'
r .
ELECTRICAL., ` —
PLUMBING ir
FINAL GAS TEST
_
HEATING -AM,
HOUSE NUMBERS
JOB COMPLETED -
TEMP POWER r VIP j