0101-259 (PAT)iW�,
,4'LICEt QED CONTRACTOR DECLARATION
Tieunder penalty of perjury that I am licensed under provisions of
Chapamencing with Section 7000) of Division 3 of the Business and
Proles. de, and my License is in full force and effect.
License
# ` Liicc. ClassExp.
'�''��pp Exp. Date
�� 1 /
iYiiPM1• S',% D03 D1 !6211 . Aa6.1"ry67A�'ES .P.If
Date_ gnature 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).,
( ) I, as owner of the property, am exclusively contracting with license -0
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
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:
Carrier Policy No.
whis 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 3708 of the Labor
Code, I shall forthwith comply wits4os provisions„,• _ il
Date: s A.4 Applicant; ;• y
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 on his
application. I
"I
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work Wperformed under or pursuant to
any permit issued as a result of this appllcaton agrees to,'& shall, indemriify•i~%
& hold harmless the City of La. Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes nulliand 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
?/ °,� " ....
Signature (Ownef/Agent) "`--'"' � Date L1 -.+21/"q0/9
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �I�Z^s,�I� TRACT
JOB SITE
APN
ADDRESS
G4•yGYKbLf 7T3 �5:1.6f,•9!YA.!'�da'.F7 6.1..5.5.6.wJlf.CL
.OWNER
CONTRACTOR / DESIGNER / EN (NEER
CARVER
frcT�1, 'M1� ut, i��r� it At��4;f;1IG Co.
LA Q'MM& CA 92253
rMA0 CA 92201
r,w))da47-0392, CL3IAH,, 4,996
USE OF PERMIT
'a,
ala& S.F. C0V?U4Ai.Li3itd.A1;1(300) VS P1fR..A1:'N;.P V9V ONLY .
PORC.1-UP.FATIO .d3OM 3F
t�
:�:.TroI�;�A'.l C'C,�;bT OF c0liff' '.. �.'i7T".'i:�ON
3,x'30.40
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PLAN CHECK FER 3 01 NC1Ut -4319.31 8 NOS
CO;P3STBiAiC` ISIlm VE % 401-000-418-000 03.00
STRONG MOVOW FEV - It�,�sID101 -000-241 • 0100 $.9
. •JAN 2 4 2001
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17-Y Ue
Li `iY i11 �CC3' kc xC:`f� 3YrT AND PL AW CH X
$1 WA
TOTAL Pi"C3#70;"DU SOW
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RECEIPT
DATEBYl
ts,:�-h
DATE FINALED
INSPECTOR
11
.
INSPECTION RECORD
a OPERATION
DATE
INSPECTOW
' �� OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Sacks ��gJ�=1
3s & Footings 3D
Slab Grade
Underground Ducts
Ducts
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 2_1_lo CQ�a`L
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
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)
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)
SITE PLAN "
NAME 1�/ /� P TONE 7 _
:5 C�e6
SITUS ADDRESS
ASSESSORS PARCEL NO.
Provide North Arrow.
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SUNLAND SCREEN & AWNING CO.
jFRONT PROPERT._X LINE
46090 CALHOUN ST.
INDIO, CA 92201
_STREET
I a I a K •= t �� D K r?
(760 .34790592 FAX 1760) M.9419