0107-106 (SOTB)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F– Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.
O co License # Lic. Class Exp. Date
Lo
' W
~ Z r– Date Signature of Contractor
CD
JI.– C) OWNER -BUILDER DECLARATION
W W r– I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ d 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C'') () I am exempt under Section , B&P.C. for this reason
LO
O N Date Signature of Owner
0)IL Q WORKER'S COMPENSATION DECLARATION
It z I hereby affirm under penalty of perjury one of the following declarations:
O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J 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
O V Q Section 3700 of the Labor Code, for the performance of the work for which this
0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
ob 7D
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 fol 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.
Date: Applicant—
Warning:
Warning: Failure to secure Workers' -Compensation coverage is unlawful and
shall subject an employer to criminal penalties an,,! ivil 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, indemnity
& 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.
1 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. 1�`
Signature (Owner/Agent) Date ,�L• /
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
k,
KSS Ct RT RbAZORTS LNC
LNL"D VALLEY CC►MMUCMON CO, ffY
494.99 EMENHOWM DR
18342 SL OWR AVE
L &Qi3iiNT.A CA 42253
BL.OoimarON CA 92316
(90W. 5. Z 112 CPTA
USE OF PERMIT
• .. • ..: i; _, , , . ":� ,'7" .':.-, �,"....- :, �:... si:.�:•IS ]-kst'!LY!'Y {!i%07 S.Ir
PQRt'WATIO 460.00 3.F
CIJLRAQW,APYOIZT m0_00 SY
AIL' -. COM11f ERCLAL 340.00 8F
OAFtA0IYCAP0R.T 667.00 Sr
XMWATED C(W OF C0N9IRIJ[' 0_N
FK100TVU GUAWARY
PIAN CHWK FSE 101-(MXI-435[-318 SAW
CONSTRUCTION TIO# Far 101-000-4 t 8-000 1271.30
MECHANICAL, FEE 1 041.000.421 -GW f37.30
I�-LLrCT1ZtCAL YKI.". 101-0 24-000 $27.04
PLUMDR40 FU 1171 -000415+ -Ow 112* 14
.`+T'RONC MOTION "A . COMM I 00-{3fbE)-24 1-000 33. JC
ART N PII11UC PLACES - COW 701.000.2354M $135.14
1DFEVF,L€7PEk IMPACT F"_ $1,119.n
<AMWCY[0X AND I'f.-,PX CM=
$1.918.71
F.SW ME PAM FM
so W
AUG 16 2001
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE
BY "
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
FA U
Framing
Compressor
Insulation
Vents
Fire lace P.L.
1
Grills
_
Fireplace T O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final � -
POOLS -SPAS
--
Final
E3L,OC1�IIVALL APPROVALS
Set Backs
_steel
Electric Bond
Footings
Main Drain
Approval to Cover
Bond Beam
Fclulpmerit Location _
ldrndarground Electric
Urxlesglr�und Pltf}. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
_
Waste Lines
Heater Final
Water Piping
_
_ T!
T
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O K. for Finish Plaster
Se4ves Latera!
Pool Cover
Sewer Connection
EncapsuiaWn
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
1.o6be� la ERim'R: 14W6 ,46M1 T.
-holo- - L21 t 001- W (P&FfE>QW
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)
I Z�jaZ.
9096944113
GI
BUILD
IN
p5�
T-943 P.002/002 F-579
)F LA QUINTA
SAFETY DEPARTMENT
777-7012
ION REQUEST LINE
777-7152
HOTEL IASL
Pgmlt Number 0107-107
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRE$$ 49-499 EISENHOWER DR
SUPPLEMENTAL TO PERMTI' 0105-121 TO
REFLECT ELECTRICAL FEES
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
ffT17UCTZ0111:I owj&i i #,`
GROUND PLUMBING
PRE -G UNITE _
OO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNEI
CONCRETE SLAB
JOISTS & GIFIDERS
ELECTRICAL GROUND WORK
1-2
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS 13 N GNE[
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- AIC
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING c
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL, INTERIOR
EXTERIOR LATH
POOP, PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUFASING
FINAL GAS TEST
HEATING - AIC
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING