9602-147 (SFD)U)
H
N U)
W
p Z) c0
0 U-)
W -
C6
(DDH m
W W
HQ_
U)
Z
ch
LO
N
ON
U °)
.Q
It CL
Cc
Q 0
X W
mUU
O
M
"tZ
co 5
C)
Q
J
// LICENSED CONTRACTOR DECLARATION'
Ihereby 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
488234 K_ 12131)/97
.,.-Date Signature of Contractor N
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 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
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 S!'f0`lr6't'VtgD Policy No. G2 _SSS
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, l,shalIlI forthwith comply with thbse provisions.._.
Applicant t`. / ' (,k,Kct ► 6 + , 7(�. ��
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.
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 authorize representatives of this City to enter upon
{ the above-mentioned property for inspection purposes.
Y / f ,�•�
Signature (Owner/Agent) (J',0if k�,; r �e° Date �1 wo
BUILDING PERMIT PERtv11T# °°NTR°`#
64)Z_147 2943
DATE,j9.6 VALUATION �J144i,lT57 30 LOTS TRAM �13 Iq�, lyr
ADDRESS 79-205 CAN1'E.RRA CIRCLEAPN .6041-.263-007
OWNER CONTRACTOR/DESIGNER/ENGINEER
IRIQ EP, SNELLFN:13ERdER & ASISSOC.. 1,0(;Eit SNF,1,1,r"N. 3E:KtiER & ASISOC.
41965 BOARDWALK k 12 - 41R65 .L301VZbVvJV K if212
PALM :l RSURT CA, 92211 PALM. T3E x"1:11'1" CA !4221, t
(619)777.77661-7766 -7766. C1 1858
USE OF PERMIT
t ,ijvc',:l,;81:'ANt1 -V 1?tNisj.UNG
C?Utld':I`ERRA
PLAN 3-R,
'IITd#lCT rv0,4S'1')2t:r0'"t'[ON
e4 1.00 SF
141-159.00 :IV
i:..s-rimA'rf D C(34'T t -w Ct7+NSTRU(Tt ON''
.P!!AMIT FEE Si3IUiVGWY
ART IN PUBMC PLACE'S - .1.213,M)'. 7014)OO-255-000
310t64
CON TRU6-"1',IONFEW
101.•OW-IIS-000
V1183,00
CiU. C'MiCAL F8C
101.-00)-420-011(1
$143.69
t::1W)fNQ
329.00
iN1: R STRU6 TUTR:C tTVF
`2254)0-4143�-;f 42
S?, I A4,79
Tvil;t."•i31IXI Ai..l-`L :
101.000,4X1-1100
$600
lai t I a i i� :l+, l iwf
101 -W) -439-31R
S(NS. 0
i?3,UMk1Ii3e r .} 1 }?
101-000.419.000
$183.75
,rc3Nci , ij' cdN i"l?R - RESI'D
10.1-000-241ki3W
$14.07
140,,07.30
100 AUNT) PLAN C1i i:K
LESS PRE-PIUD FEFIS $0.04)
MAR 14 1996
RECEIPTDATE ' BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings j
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck Lit
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation 2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL P ROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final I
Gas Piping
PLUMBING AP RO ALS
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
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
FinalOF
Utility Notice (Perm)
COMMENTS: