9907-426 (SFD)LICENSED CONTRACTOR_ DECLARATION
I hereby affirm 'under.penalty of perjury. that l'a'm 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
10/3 /201
ami r! ': ! t I f I.11 'L+'� i.
„Efate Signature of Coritractor —p
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'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 the property, am exclusively ^contracting with : licensed
contractors to,'construct the project (Sec. 7044,' Business & Professionals
Code)..
O I arr exempt under Section B&P.C. for this reason
Date 'Signature of Owner,
WORKER'S COMPENSATIOWDECLARATION "
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 ofLthe 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 ;�.iNT) 3€6'1-.99�tifrit3l:
(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
subjectlt the workers' compensationfprr',91
islons of Se tion 3700 of the Labor
C,��de, I all.fo tiw -comply with thoselo fso te: �> /; VTApplicani f t �� '! tl l
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. r
IMPORTANT Application is hereby made to the Director of Building and Safety
for. a. permit subject' to the 4conditions 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
correctA agree. to comply with all City, and State laws relating to the building
construction, and hereby authorize represent tives of this City to enter upon
the above- mentioned 'property for t,
.y rrpos�els. r J„
Signature (Owner/Agent) +t (� , l� U Date S
\.J' • !:'
BUILDING PERMIT PERMITA#raaa . y
DATE ( VALUATION LOT (�.x�ael7-42:6 TRACT
f
S1:i"'56.4#D .9.. ' .. 2"53
JOB SITS
ADDRESS y 329 ♦ q 9 t� GF! �t
f �.�ltl�P VI'sir1 tY�fDill
t6 hyN ey N a
OWNER '
CONTRACTOR / DESIGNER / ENGINEER
t �+.t' v ,�q D i}'JlTal.lediri�]:�4 4a�!';;' ir�..
SCLC HA,�tTA24DWTLri..t.�.1�S,1}InS>5..4�C.,I C,
77 -WAV EMM, COP THE STATES
77-900 AVI3><\iUE OF THE STA 1T3
P.AILM DESERT CA. 92211
P,A1.,IVEDESERT, , -CA. 92211
(7i :1.5- 26 ... 1; 0 . S203
USE OF PERMIT
SFD - LCVV 41, FLAK U, ly,'E�t3��!_i' :iJORSI':1NOT YNCLum Ef,&,X -ArALL OR ,
POOL. '75Th PLAN t'F1ECK .FEE FOR. r4I .'i,°I"11P[.k YS;SU.4.qAM OF SAW-.
1i71ACT CON19FRUC-1 0,M 1W.
PORMPAIT10 120,00 ST .
GA AQW- CARSIOEt'E
1`
)i 3' Ii,'f ' '8!..19 COST 9�s'& 1�l $�t�-`STI Rt C IO
TIORMIT FEE SUMMARY
CUNS'7'i2:t71"7' it3lwi 1 Oa -530;- d 1.4• 5776.00
PLANT CHECK FEf:
�IMEC 1A;1 C -M, Eli Sii l ' 49 2 t 0(1ci $feoi O
� '+
16,14 W120.ON 51150.413
4
!'F.T�11i111`fCEF1• 101000439-000, 11'.io•
s"TRONG MOVON FEE -IM-80 ,.1 Si 1 t3i3t3-I $ 3. 3 13. Sti
Lipa t7,tCi P F 101
i
iit31•RAS'CRUCdUR6 ,FFJF
PRI C;ESE-PLAN 101-000-44:1-30 -'_325.001
ART ;art;Pt.fBLI..0 .PL S RES1C 701 -0041-255-000 $�� 3�
� � t
- `�I.i. •'JI.I ..�l�i�'��.i��.i./ �.i [A.I�✓
5i�i V�
l
Ta.rAl� PERMIT FEES 'DUE NOW
$4,656,&1
RECEIPTDATE
'1#Y
.�
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
C�
^�-
Ducts
Slab Grade
l2
t;
Return Air
Steel
Combustion Air
Roof Deck
%O—
Exhaust Fans
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
��_2—�
�'
F.A.U.
Compressor
Vents
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath /2-.(
Final
Final
POOLS -SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
8 ��_ _
6
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
C
�Z v 4
'L'
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) Z-$_ i�