0008-148 (SFD)LICENSED CONTRACTOR DECLARATION
I 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
�74til ✓' .d' U ,i2l2E
.Date' Signature of Contrae or r'
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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors.to construct the project (Sec. 7044, Business & Professionals
Code).
O 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.
( ) 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:
CarrierSTA,EIIFUNI� Policy No. 046-00(x,38
.(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 aagree that if I should become
subject to the workers' compensation provisions of Section 370 of.the Labor
Code, I shall forthwith comply with those provisions
Date: Applicant
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 per 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 Quinta, its officers, agents and employees.
2. Any permit issued asa 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 nspectjonpurposes...
Signature (Owner/Agent)- Date f1�`!%r�t✓
BUILDING PERMIT PERMIT#
` 0M-1,49
DATE VALUATION LOT TRACT
S28:2,106.00 115 29457-1
JOB SITEt�
ADDRESS iC fe.ly, r.i ae n+l
APN
64.9 OM
OWNER
CONTRACTOR/DESIGNER/ENGINEER
TD=9'6eRT I)FIIEL0T?2�.1!•'.%1T
SPAIMS CONSTk2,i7t^°i`T 14
PO BOX 17.16
7.9.295 R.A ICi3.01,A Q IN TA DR
X. A. QPW, A CA 32253.
LAQUWTA CA 922$3
(/60)771.1941 CWf 2996
USE OF PERMIT
MHO LE 1rA LX LtiWHU,lNG
wfer,. I,OT:115 PLAN.MIR - P912Yy IT DOYS NOT rklUD8, HLOCKWALLZ
OR POOL, 75°la PLAN C.H.EC K FEE REDUCTION FOR MUVIPL E ISSUA14CI :
OF MUS PIA1,11 TYPi+.
CUSTOM CONSTRUCTION 3,340.00 SR
PORC.HYP AT10 , 590.00 Sl? .
GA.RA(SRYMPORT (SF) 13.58180
l LIUV" FEE Si"fA4uh![L. zy
CONSTRUCTION FEE 111.000418.000 $1,290,00
rr.�
PLAN CHECK FEE
's'.3
MECHAO1_C.AL FEE 101=000-421.000 $149.50
WIFETRICA1,Irer ;o1-000-420-001
PLLIMBT1401101-000.419.000
S7RON0 MOTIQN FSE • RESID 101-{:'00-24ry1-OQ0
F c1 { #
g02p$.�2yp1
OR.ADI•NQ FETE 101-000'42`3,000
t
DZY'2110PER IMPACT FrIle,
ARTIN PUBLIC PLACEIS � RESK 701 -000455-00
a
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- 'AL CON nR UC1'10H M .PT W 07 c:K
X4,27i . �o
:1 ZUS 1=!TME PAM PW.,
RECEIPT
DATE t
r
BY ,
,.,
DATE FINALED
INSPECTOR
j
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTO
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_/01,
2 (p--
Underground Ducts
Forms & Footings
Ducts
Slab Grade
2 // da
Return Air
Steel
Combustion Air
Roof DeckExhaust
Fans
O.K to Wrap ��(a -��
F.A.U.
Framing—��
��
Compressor
Insulation
� 0,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
'
Final
Final
6
PO L - 'PAS
BLOCKWA -L A PROVALS
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%-
L� �v �jC
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:
Final
Utility Notice (Gas)-d�
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
yr!��
Temp. Use of Power
Final
Utility Notice (Perm)