0205-108 (RR)LICENSED. DECLARATION
| hereby affirm under penalty ofperjury that | am licensed under provisionscf
Chapter 9(commencing with Section 7OOn)ofDivision 3cf8`e8boin6smand
Professionals Code, and myLicense ioinfull force and effect.
uoonne # uv.c/ueo Exp. Date
�li4�157 C39
/Date Signature of
' Contractor—
OWN ER'BU|LoER! 1���AAoJ|ON
|` hereby affirm under penalty ofperjury that |omexempt from the Contractor's
License Law for the following reason:
( ) |, as owner of the property, o, my omp|oy000 with wages as moi, oo|o
compensation, will dothe work, and the structure ionot intended oroffered for
sale (Goc.ro44.Business & Professionals oodo).
( ) |, as owner of the pmperty, am exclusively contracting with' licensed
0onU(ktors'Nchh�irD(t'h6pnojiact'(Goc 7044. 8usineno~8 PmfevniUma|o
C«�»)'
ptB&P.C. for thisreason
Date -Signature of'Owner.
COMPENSATION
WORKE.DECLARATIOk, '
:1 hereby. affirm under:_O�nalty of perjury one, of the following declarations:
,,�ompensation, as provided forby.S6ction,3700 6 he La
Oerkrmaice.of the work for Which ihis'perAt i S* issued.
Section 37001�of the Labor Qocl�,"_f *the performance of, -the,- - W6rk:for , which this
rm
Policy
(ThiS section needno"t be completed if the permit va,luation is for $100.00 or less).
I certify that in the'performince of the work for-whilch this permifis issued -
I Shall not. empl6y.�any person in any-manner'so �s'to �become subject t6:the,
wo rke rs'; compensation laws.6f California, and agree that if I should become
subject to the workers' comoen stitibri, provisions of Section 3700 of the.;Labor
Zode, .1 shall forthwith comply withi'th
ose provisions
Date: Applilcint—
tion coverage uhl. ful and
Shall subject an employer to criminal penalties and civil'fines up to $100,000, in
addition10 the cokof compensation; damages as provided for in Section 3706
of the. Labor Code, interest, and.attorney's fees.
IMPORTANT Application is,hereby iTiadeto the Directorof Building And Safety
fo I r* A. permit subject t . o the conditions and restrictions set fo�h on his
1. Each person upon whose behalf.this application is made & each pe��son at.
whose request and for whose benefit work is performed under or Oursuant.t.o.
any permit issued as a result of this appli , Caton 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 apokation 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 wi.11 subject permit to cancellation.
|oortify that | 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,ilnso6ction purposes.
/
'
Signature (Owner/Agent) Dater
Pa., 5 108
DATE VALUATION LOT TRACT
JOB SITE
APN
OWNER
CONTRACTOR DESIGNER / EN61NEER
USE OF PERMIT
uuxa
CIT TA
RECEIPT
DATE
BY
FDAT,11E FILED
ISPEET 01�
LINI
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck/�
_
Combustion Air
Exhaust Fans
O.K. to Wrap y
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lires
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
Final
Final �% 0 r
1l
POOLS -SPAS'
BL®CKWALL APPROVALSSlee!
—�—
Set Backs
Electric Bond
Footings _
_
Main Drain
Bond Beam
Approval to Cover.__�—
Equipment Location
'
Underground Electric
Underground Plbq. Test
Final
Gas Piping
PLUMBING APPR®VACS
Gas Test
Electric Final
I
Waste Lines
Heater Final
Water Piping
Plumbing Final - -
-
Plumbing Top Out
Equipment Enclosure
-
Shower Pans�T-tJ
Sewer Latera:
iC,_for Finish Plaster
Pool Cover
Sewer Connection
Gas Piping
krcapsufation
Gas Test
Appliances
Final
Final
Utility Notice ,(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
�1
Underground Conduit
Rough Wiring
_
Low Voltage Wiring
i
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Fina!
Utility Notice (Perm)
- T