0009-098 (RC)it LICENSED CONTRACTOR DECLARATION
J hereby 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. Dafe
7478,66
Date /7 IE Signature of Contractor--
f`
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 exclusivviy 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.
U I have and will maintain workers' compensation insurance, as required by
S�iftion 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 Policy No.
(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 shall forthwith comply with those provisions. r
Date: Applicant ,r
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.
r i.
Signature (Owner/Agent) !_ r�''j�w Date 7 '
BUILDING PERMIT PERMIT#
r
DATE VALUATION LOT J)Wj.01A TRACT
„ I I .M- 100
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Y,91 11AU .s I C'0R "T'i0H
MIL LAND U CORPORATION
r.
55-92tyigq��'�Cr./,�,BLVD
TT551,9�2��,�Uy�F,,7�'G,���:
��r.tt,y t,AI�z�+yy
I. AQY.f.S.eV4. A CA. '9_2253
�Nv
iA QLdn 1A CA 922.53
C/60)}S644166 C8U. 5323
USE OF PERMIT
4:W�i.�+ AI, X�LWQDE .
REMO:DE), C.. $ M0141'ANA S - FOR BY LE ULTNI.ARDINB
VALUA110N 1.;s
167 yt1:.ihi✓ 47.0yr R9h- 1.ri.I'F.'t.A7A.8'O.id1..SlT0 11
.riYV1R3Y�.i/��
11C,HE, M 101-000>439.318
CONSTRUCTION- UCTION- ME- 101 -000-d.18-000 ��tiU�v.OQ
mt-CgiANIC AA, FEE 101400- 21--000
1I.f1VPI:I A1.,FEE 101-OM420-000
P1,1r 1.'[14 3.F&F, 101-000-419-000 340.U0
8T.R.UN O M.0'11014 FEES RMID 101-000-241-000 $10 ).0
ART N PUBLIC PL4%C - RM1 0i-000-2g;i'-000 Wi 910
<} e
S, SR�r���^^ ���A�pp ,�q-�.�•, ym. ,o.��7d��,y L}� �'t( Tye �py,�j�^ `y
-- LQiL� CONOTR?{.ii.+1LiO AWD S'(.nt'L:♦7 �..�L7.�.R... ,
t
YUi7
RECEIPT
DATE
jBY '
DATE FINALED
INSPECTOR
INSPECTION,'RECORD'
4
j
OPERATION
DATE
INSPECTOR
OPERATION IT
DATE.
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts , . I .
- 1. . -
Slab Grade
Return Air -•
I
Steel
Combustion Air
Roof Deck
-Exhaust Fans
O.K. to Wrap 4
F.A. U;
Framing
Compressor
Insulation
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
POOLS - SPA'S
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
.,Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground P[bg. Test
Final
Gas Piping
PLUMBING APPROVALS-
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
COMMENTS:
7
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)
y ,
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT IQ
�FM of 777-7012 _
�sop
SPEGTI9N REQUEST LINE
® 777-7153
® DESERT -RESORTS INC
ne
�e Contract WNER/BUILDER
Permit mber 0009-098
Ru
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS
49-499 EISENHOWER DRIVE ,
REMODEL OF MONTANAS - AZUR BY LE-
BERNARDIN,
TYPE OF INSPECTION
FOUNDATION & SETBACK
FOOTING STEEL
=-INSP*
MAIN GROUND SYSTEM
GROUND PLUMBING
.PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEeIv
5wintu
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUNDWORK
DO NOT POUR CONCRETE UNTIL -ALL ABOVE HAS BEEN
SIGNED
ROUGH ELECTRIC 1-
'
ROUGH PLUMBING.•
ROUGH GAS & GAS TEST
` 3
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND,BEAM .
O.K: TO WRAP
GROUT 0.4' O 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL'ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE '
SEWER SEPTIC T K "
FINALS
ELECTRICAL
PLUMBING '
FINAL GAS TEST
HEATING -A/C
HOUSE NUMBERS
JOB COMPLETED
- TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Undergiourid Flush
r Date Inspector
Overhead Static
(200 PSI For 2 Hrs. Prior to Inspection Time)
Overhead Final
Date Inspector
Fire Main Installer
Date Inspector
Underground Static
(200 PSI For 2 Hrs. Prior to In, Time)
(Center Load Pipe -Only, Joints and Thrust Blo
cks Must Be Exposed).
Date Inspector
Underground Flush
Oc9 U
�Installer �' � �� t�(P
tem ✓
Extinguishi g Sys S�
Final
Dale spector
Fire Alarm Installer
Date Inspector
Final ,
Tank Installer
Final
Date Inspector
FINAL for OCCUPANCY.
Date
Inspector
DO NOT OCCUPY THIS STRUC ON. UNTIL
AFTER FINAL INSPECTI
264-159 (Rev 10197)