0205-100 (RR)I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with S-ection 7000) of Division 3 of the Business and
Professionals Code, arid my License is in full force and effect.
License Lic. Class Exp. Date
Ly
,6 a t
el Signature of Contractor 4_4
OWNER -BUILDER DE&L'AR4THiN
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 -dr.off Bred for
sale (Sec. 7044, Business• &' Professionals Code).
1, as owner of thiiprop&ty, aiii.-exclusively contracting With, licensed
o '
contractrs. to const I ruct the -project Sec. 704. . 4;"Business .&--P'rofessionals
Code).
(J I am exempt under -Se'c'tion for this. reason -
of
Date Signatulre';� Owner
WORKERS ,COMPENSATION .,DECLARATION;-.
-.1 hereoq affiA _u*rider,-_'pe'nalty 'of- ;p'p'!j"ury"q•n�e'-,,,'of the following- declarations:
I have and w'i I I maintain
ia certifk'ateo.xtconsent,to sel-insure
for 'W,brkers'
compensation, as provided for by Section3700 of the Labor ode,
f6r* the
performance'of theworkfor,which, this permit,is issued.,i.,
I have and wi maintainvorkers compensation - insurance, as. required by
Sebfion'3760 of the Lab6r, Code for the performance of the Work Jor: which; this
permit is"issd6d..:My ! Workers' compen§ition insurance' 'earner & p6licy,no are'
P6` I IC 0:
Carrier
(This sectiomne6d,not be completed if,the perirnit val6ation'is for $100:00 or iesi).
116ertiiy that in the 1p'drforr� a -A :ce ofith e`w6rk for -which this permit is issued,
J shall not,employ any pL-rsbn:ih any manner soyas to becorne Subject t6the
'k� ' Yhsh66ld bec' '-'
workers.' `compensation .,laws: of, California �,,,andl'ag re -e' :t at'i orne
'subject . ... .1.1... , . I I � w�l
,_to1he'work'e'rs compensation, provisions of Section .3700 of'the ,Labor
!Code l.sha'li46rih %_Oh comply "with those provisions.
EBtBAnnlirA-), :'- " n -t
-1
' and -
Warnini: Failure: to s'dc'ijre.-Worki--rs!;Compensation-co�6rage is'unlawiu'l
shalFSubj_e'c't"a6_n employer;to criminal pena - Ities and civil fines up to $100,000 ,,'in.
pdditi8r�t6lk6,6osf -of com'"pens-atiok, 6am�ges asprovided for in . Secti6n 3706'
of the Labor Code, interest and attorney's fee's.
IMPORTANT A00kcation is herebymia'Je to thetiirector of,Buiilding and Safety'
Jor.a,p ir!�tsubC
, e t _tp.- the. conditions. and:,'restrictions -set-,,forth oni his'
-
.. .. •� �r .-
application.
.1. Each'per ' son 'upon whose behalf this application is made & each:pefson' at
,;�hose'reiquesiand for'whose benefit work is performed under
hder or pursuant to
any permit issued as a res ' ult of this applicaton agrees to, &'shall, indemnify
& hold harmle'96 , the City of La Quinta, iis.officers', agents:and employees. -.-
2. Any permit issued as a result of this application becorne§*nJull and void if
work is -'rot commenced within 180 days'fromdate of issuance of such
permit, or cessation of work for .180 days will. subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the /above-mentioned property for inspection purposes.
Signature (Owner/Agent) f
DaW
BUILDING PERMIT JILHMI I o
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS
✓
APN
OWNER
CONTRACTOR DESIGNER EN (NEER
0�NHi I'Ai'kVW
USE OF PERMIT
)A i'tf
.4
4 �:_..___ fi
P
I CITY nf
- -
FIM 7t
Ir
7.i1 )! A N1)
RECEIPT
DATE
BY BY
IDAWI$L
IN' TPET
OPERATION
DATE
INSPECTOR
OPERATION
DATE INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
I
Set Backs.
i
Underground Ducts
Forms & Footings
0!Uv. Tes'
Ducts
Firizi —
--
Slab Grade
—j
Return Air
;
' PLUM8
Steel
_ --
Combustion Air
Ga, T<<_:
---►______-__.. _!
Roof Deck
O.K. to Wrap
—_'
Exhaust Fans
F.A.U.
:Nasta Lines
Framing
Compressor
: �•: i� ;
i
Insulation
Vents
j
Fireplace P.L.
P;crroing Top Gt,j
PantK_r.±
Grills
Fireplace T.O.
I Fans & Controls
Pa,t� Wall Insulation
; Condensate Lines
i �rv:.er L rt+.ra!
j
Party Wall Firewall
Sewer onnesi'ton
Exterior Lath
!- fir• >nsu;� —
-- _ ___. - .__.- --- —
Gas Piping
Drywa!I - W. Lath
__ _
_
BLOCKWALi. APPROVA- S
FOOLS SPAS,
Se! Backs _-�
�-
1
Electric Ecnd
i
Bond Beam;
! —
1 ,Aayr: ,')ve;
i—
�—
----
I
U;werercur;d Eiecu,c
i
0!Uv. Tes'
---� _ - ---- - -- 1
Firizi —
--
j
—j
Ga: Pion
' PLUM8
NG APPROVALS{
_ --
Ga, T<<_:
---►______-__.. _!
—
—_'
`
:Nasta Lines
�.__
: �•: i� ;
i
Water
P;crroing Top Gt,j
PantK_r.±
�4 J`:'!E•'
i �rv:.er L rt+.ra!
Sewer onnesi'ton
!- fir• >nsu;� —
-- _ ___. - .__.- --- —
Gas Piping
_ _
__ _
_
! f% Test—
- ----
-- -;
CL,IME i s
1
�SflBf �
s
�Uilf?;, Nc.bce (Gas)
± E'LEC
TRICAL APPROVALS
Temp. Power Pale
EUnderground
Ccndu
R•�t:gh Whin -
-- �{I
-T---------
�
•
rMain S3ivice
I Sub Panels�_—
Exti erior Receptacles
C F.I.
,Smoke Det,:: tars
Temp., us: of Power
Wility Notice (Perm)
-- --