0008-123 (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 Ex •Date
/31/2C
Date t'' r') ' Signature of Contractor � I/
`51......_ Ie i
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)..
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
ti
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 3,700 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 FIND Policy No. .6.000'338
(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 1,shpiuld become
subject to the workers' compensation. provisions of Section 3700 of the Labor
Code, I shall forthwith comply with t reJ a provisions.
Date: / "" Applicant
.S
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.
BUILDING PERMIT PERMIT
DATE VALUATION LOT 123 TRACT
90 2-9457.1
JOB SITE APN
ADDRESS 4!'-21.0 VISTA Xsnmi A. 94W—W9
OWNER CONTRACTOR/DESIGNER/EN (NEER
11) ].iFSMT DFNELOPNONT SPKJZXS C0148T U=0
PO MA 1716 79.295 RANCI.10 iA QTJIWfA DR
LAQTJDrCA CAS. 92253 LA QUiM.A. CA 92253
(760)7'71 m.l941 CS1.1 2996 .
USE OF PERMIT
SKY[). LOT:90 PIAN!MIK- PEiNlff DOES NOT INCLUDE i1LCICXVA.L LS OR.
POOL, 75% PLAN CHECK F99 REDLIC;`f:IOM FOR 0.41S1.MPLE ISSUANCE OF
SAME PLAN TYPE,
CUSTOM CONSTIWC-TION 3.343,00 3F .
,POiiCWPATIO 380.00 5F
GARAWt ARPORT (3F) 13;532.$0
aWAT D COW OIC' CO➢�iSINUCl ON' .
y�•�q •� Sys �y�p. +
PF14SY1Ll. d/ Y'T gUAWA .8
CON$'1 ROCTION F.EL
101.000418400
$1140.00
PLA14 CHECK FEE
$M.23
MECHANICAL: "aA
101 �.OnCs�4z1 ^dOC)
31.49, St+
1,FL ?CTPJCAL P EL
101-000-420-000
$2115.04
}
PLUMING FEE
101.0004194000
$202,25
STR.ON0 MOTION 1 = RESID
101-000-'241 -000
$28.21
iiltADING F,
1.111-0004 ;��OOii.
$24.00
DEVELOPER FEE
�1,$07.it0
1�1' IAI PUBLIC PLACES - R,ESIE 701.000-7.55-0030
$2135,27'
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
& hojd 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 :_
`Z: ` / RECEIPT
Signature (Owner/Agent), -f r Date'
9- TJB-'.1.'C)TAL C -014U RVC-TIOM MD PLM CM10C
LESS PRFI-PAM.M11+13
7't A -L rk di1 FEE's DUB !how
f. `t fti � I BY:'! -t I DATE FINALED
r�
K,'t."y l .SQ
$0.00
$:1271."
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 Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath
Final
��—
Final —Z
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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 2 !�
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—
Utility Notice (Perm)
COMMENTS: