0205-101 (RR)��—__—� ......-...... —�.^..,,..°m
I hereby affirm under penalty of perjury that I am licensed under provisions of
~ with _~~,-7000) �~~~,sid..~.the Busine~and
~
pmmvommu/oCode, vnumvuoonoommbmmumand effect.
'. uoommx '_ ' ' 'uv. Class Exp.oam'�t'
.".1/4,V7
uam �
/� �
^/ of
Contractor
| hereby affirm under penalt y of,perjury that I am exempt from the Contractor's
License Law for the.following reason:
( ) 1, as owner of the property, or my employees.with wages as their sole
compensation, will.do.the w6rk, and the structure is not intended or offered for
1,'as owner 6f thE.,property: am. exclusively contracting with licensed
contrac . tors to' construct. th e proj . ect (S�c. 7044, Business & .-Profession . als
I am, exempt under -Section B&P.C. for this reason
Date —7-4$ignature..of Owner
V hereby_ affirm under p6halty of pqrju`r� �oqe,: Of t , he�following I declarations:
er
�prmanc which this permit is.is§ued,-
work . ers, compensation Iaiwsof.`C'aIitomia, and agree t,hat,i,,f I should becom6
Codej sh 11 forth ith comply with those provisions.
-Date* Applicant
Warning: Failure to secure Workers' Comp'e'n'-siatio ov6rage is unla�iu'l -and
of the Labor Code, interest �ndktiorney's fbes.
IMPORTANT, Applic.ation..is.-hereby made,to the Director of Building and Safety
4gr 'a. pqrmit,�SubjoCt JO the 1-corfdiiions, and restrictions set fortK,onhis
application. a
ll.tacl�persori' upon whose behalf.this application is made & each person at
whose �equest and for whose benefit w6rk is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harinless the City of Ca Quinta, its officers, agents and employees.
2. Any permit issued as a reiult 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.
/ certify that | have read this application and state that the above information is
nv,evt. | agree tocomply with on City, and State laws relating mthe building
onnstmction, anuxooaoyavmonco mpnomanmtivov of thio/Qty to enter upon
the above-mentioned pmpenyoo,inspection purposes./
| (Owner/Agent)` oa��
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
APN
OWNER
CONTRACTOR DESIGNER / EN61NEER
ITY
USE OF PERMIT
41
uI) ........
CITY 'OF LA QUIM-A
RECEIPT
DATE
BY
AT
rINSPE�V
INSPECTION RECORD
OPERATION
DATE INSPECTOR
OPERATION
DATE } INSPECTOR
BUILDING
APPROVALS
� MECHANICAL APPROVALS
Set Backs
' -
Underground Ducts
Forms & Footings
- `— ----�"
Duets
Slab Grade
—
Return Air
Steel
------_ - _; ..
( Combustion Air j
Roof Deck
�Q
Exhaust Fan= j
O.K. to Wrap
_ -
-
-
---`-
_—
Smoke Detectors
,army 1
Insulation
Fireplace P.L. j
l Ull'p;ub:su'
bents
GrOI=
- I
!
Fireplace T.O. j
Fans E Controls
-
Parry Wali Insulation !
Condensate Lines
' -
Party Wall Firewa ;
- `— ----�"
Exterior Lath--
—
Drvwall - Int. Lath ;
"--`— ------
------_ - _; ..
Final
I BLOCKWALL APPROVAL
Set Backs ! _ nc
Footings ' -t.ia n'^ � - - -- - -- - - - -- -- -- -- ---,
Eond Bear
-- - - - - ---- ---- - -
Fina' !-
PLUMBING. APPROVALS
- - ---- -
( Waste Lines
Water Pipin,
Plumbing Top Out,
_—
Shovrer Pans 1 --__._—_.� _ -- =, • -- -- _ . --- -- f
Sevier Laic,ui
Sewer
_ _ .S • i
Gas
Gas Teat -- - - - -- - -- --- -
Appliances' i _ _ --,- --- --- - - --_------+
I Uti,;y Notice (Gas). --
-
`
-- --
----- -
r
ELECTRICAL APPROVALS
,_-amp. Gower Pole
-
Underground Conduit
~Rough Wiring
( Low Vckage Wiring
Fixtures
-
---�---�
M,am Service
Sub Panels
j Exterior Receatacles
G.F.I.
-�--
-r-------.
---'
-
-
---`-
_—
Smoke Detectors
Temp. Use of Power
--�—
Final
—
Utility Notice (Perm)
—