0008-105 (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
Date Signature of Contractor *�
OWNER -BUILDER DECLARATION /
I hereby affirm under penalty of perjury that I 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). f.
( ) I, as owner of the property, am exclusively contracting with' licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section. B&P.C. for this reason
Date Signature of . Owner
WORKER'S COMPENSATION DECLARATION
.l 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:
Carrier. STATE PUNID Policy No. 046.000"39,
(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 shop d become
Subject to the workers' compensation provision of Sectionf3700 f.the Labor -
Code, !shall forthwith comply withhose provisions "`
Date: _z l ifs Applicant
Warning: Failure to secure Work s'-Compgn on coveragetis•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 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
correct. I agree to comply with. all City, and State laws relating to the building
construction, and hereby�authonzelrepresenttives or,t}his City to enter upon
the above-mentioned property for inppection purposes.
JG
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE {{ VALUATION LOT 1006-105 TRACT' t
r,
# ! t{ I.z 72. 29457-1
JOB SITE'
APN
ADDRESS �sovmu WR, MY, A
6494,W -M
OWNER
CONTRACTOR / DESIGNER / EN INEER
Ti''i:Jl'.�'I. T DLIiaC.0PNI d'T
OPAFtICS CON tTM1014
PQ BOX 1716
'79-295 RM0101AQUI T`.�a:t9R
LA. QUDr!'A CA 92253
1A QUINA CA 92253
I
(760)771-1941 CBL# 2996
USE OF,PERMIT
e�T9+1OXY,FA1VRLY %bV.��T,WG
SFD-- I.CiT-rR FLAN -ACI ;. - PERMIT DOES 140T rddt':LU DE f3LOCP>WAL) S OR
POOL. ?5% PLAN CHECK IEE REDUCTION FOR IJlCIIMPPE ISSUANCE OF
SAME PI-A.V TYPE-.
COSTOM CONSTRUCTION 41,24190 OF
PORCHIP.A.TIO.' ' 522.06 SIt'
GARAGUC:ARPO.R a (31?)11916.00
E-S'I A,T1+x.7 COS' ' Or, OOWMAJO.MN
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P r r FE''E.diJi
CONSTRUCTION WE' 101-000-418-,000 ' p,$21,50
PLAN CHECK TICE 101-000-.439-319 i`3
r` A.
C!•iMIC).AL ME 1101»000-421-000 81.16,,56
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ELECTRICAL F&B 101.-000-+'I',G'0=000 44631
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4'Iaifh1�1I1NCI1"lr 101.00Q-419-000 82050
VRONO MOTION FES - RESID 101-000-241-000
ORADINO:FU 1Q1-OW42!.000 ' S2b.a0
- 2"+•2.W
0I+"V`ELOPLR IMPACT FEE
ART 11.8 PI1.RUCP PLACES - AM 701.000.255,000 S ;47
SUB-`t`alAT, CC`iNSTRUC;`�".It' N AMS PI AR CT-DMK
,754.0'
L= MM -PAID 100
$0.00
'!MAL MCF, NOW
S4,759,05
RECEIPT
DAT
BY ;
DATE FINALED
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
,3 �1Exhaust
Fans
O. K. to Wrap
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
fJ
p ,p66—&Drywall
6�y
-Int. Lath Q
Final
�
Final
!
POOLS - SPAS
BLOCKWALL A ROYALS
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
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
,c�J
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)