0312-125 (MISC)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chaffer 9 (commencing with Section 7000) of Division 3 of the Business and
WProfessionals Code, and my License is in full force and effect.
M License # Lic. Class Exp. Date
LU
C) ZO � Dat �� 4 '* ?7&gnature of Contractor 4 ,��/� r
P C:) OWNER -BUILDER DECLARATION LARATION
J
W WIZ I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
ul
N Date Signature of Owner
ON
Q WORKER'S COMPENSATION DECLARATION
C) Cr I hereby affirm under penalty of perjury one of the following declarations:
U') FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W l= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers' compensation insurance, as required by
d U Q Section 3700 of the Labor Code, for the performance of the work for which this
d a Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carver ZURICH AVERWAN Policy No.
ao � WVISF01::1100
C7
J (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, I shalltforthwith comply with those provisions.
Date: Fpplicant le� /.f
• Warning Fa uv o secure Workers' Compensation coverage is unlawful and
shall subject an employer toacriminal 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 propefyfor inspection purposes.
Signature (Owner//Agent) Date s )
L
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01311 IS" TRACT
JOB SITE •
APN
ADDRESS W. 401 VLA MOM A7.1TL
762 7 (l W,)
OWNER
CONTRACTOR/DESIGNER/ENGINEER
11t01,,'1'A.A?,0LPARTN RS, LLL'
DAVIlItPf�0
177(* :W ITT R I34C>NEO TYK1; Y
169 ;a,, J.xc RY JZOAD, ;:,TF: ' 0.,
Pul'TLA2JT) t_�l. Q1)24
BtNCIr1CI'E1.`► CE, -biz!
{7&0)634-2'>0
USE OF PERMIT
Ad!'3�)s"i.i..A211?171J
Si'U • I.t)T 14 LAN 3 R- :;UPPLtMLNTAL TO TIEV21AiT V9JI t OSS
RK14, ;t' rrN0 0t1I111FCTE11 ADDRF.1:3
ESrR1fiA ."D COST OF CION grl?-uG"110N
tl nL
PERMI-I141.'t;iJ1 %. IARY
SUPPLIPW HM, PPRM)T l fi_' 101-000 42:4 000
"AE
11(J--Tt TM/ IONS PTM1 W1 ION AN1) PlI AiJ t,.11ECK
: :t'u
16 ` 3 YRE -PAID ITF.;
t
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T01AL 4%kKIT FE FS DUY NOMI
V
RECEIPT
DATE
By
DATVI
INSPE
TE
LED
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
ot
Combustion Air
Roof Deck
2 a
Exhaust Fans
0. K. to Wrap
L
F.A.U.
Framing
Compressor
Insulation
o
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVAL
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
fEncapsulation
Gas Piping
Gas Test
L 7
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:
INSULATION CERTIFICATE
A
This is to certify that insulation has been installed in conformance with the current energy
regulation, California Administrative Code, Title 24, State of California, in the building at
80-901 VIA PUERTA AZUL LOT 19, PHASE 1, LA QUINTA CA
CEILINGS: /
TYPE: BLOW MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Owens Corning THICKNESS: R-19
GENERAL CONTRACTOR: DAVIS- REED CONSTRUCTION LICENSE :#
a
BY: TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 2 1517
r
BY: LAh. tAl. TITLE: ACCOUNT REPRESENTIVE: DATE:
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