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0004-0114 (MFD)47750 Adams Street , LICENSED CONTRACTOR DECLARATION PI hire%y 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. Date 7226C4 0/ C Date -3 ' S t ``' Signature of Contracto >X` k \t OWNER -BUILDER DEC&A,RATION 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 theii 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 exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). () I am exempt under Secfion ;.., B&P.C. for this reason Date Signature ,of Owner WORKER'S WORKER'S COMPENSATION DECLARATION I 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. (\A I have and will maintain workers' compensation insurance, as required by Section 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 TANNER INN D OKF Policy No. =14196959 (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 -4,11 should become subject to the workers' compensation provisions of Section 300 of the Labor Code, I shall forthwith comply] th those provisions: --- -r Date:. °aI L(i APPlicant\ --- 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 :pet 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 Signature (Owner/Agent) • ^Date BUILDING PERMIT PERMIT# /f ( DATE VALUATION LOT -114 TRACT - I VAbd 110 W99.654 JOB SITE ADDRESS 47-750 ADAM KrRM APN 649 -OW -M OWNER CONTRACTOR / DESIGNER EN 1NEER tf SANOS CRPRAM1 1W_ VPi14011 C46CYiAU0D`Y 1341 "W, ROBRMOOD DR, 1341 W,1RODINE100D DX_ ' SOUMLASMAS And' 89109 5OUM VEGAS N4' 89109 (909)786-4777 MR 5906 USE OF PERMIT iulM'n-FA .Y DVP_J_L AT(s . M.FD•961 UNITS-BUILt7,WI g. TYPE 4G- PERMIT DOES NOT INCLUDE BLOC1 WALL OR POOL PORC MATZO 2,064+00 SP £IARAWCARPORT I,M.00 SF BRWW AY 1,072.00 RF APARTMENT UNIT 15,304.00 SF r E5'i71a9m'xm cosi 4P' O"G?.jYsi-RIJC.°11'iox 5 J .,'`036, .00 1''MMIT Fitt SeUT.l6f 1,1'ZY _ PLAN CHWK 1+EE 101-000.439-318 $2,430.62 CONSTRUCTION FEE 101-000-419-000 $3,350.3 . .Jt t iik;GHANICAL FEE 101.000-X621.0019 tLECTRICAL PER 101-000-420-000 $1,111.24 '-1 PLUNIHIN10 FRE 101.000-419.004 $1,224.00 STRONQ MOTION FEE - R.ESID 101-000-241-000 $93.61 GRADING WK 101-000,4231,000 $20.00 ART 1N PUBLIC PLACES - USIr 701-00©-255-000 $1,840.16 DEVE PIR IMPACT FEE 119,216,00 SUB-TMAL CONS+1' IUC N AND pl w CE1ECK $30,002.33 IYM PnI -P.ATD — $0,00 T1ML PEW&FEES DV E 14hy . 001002M IIIIIIIIVIIIIIIVIIIIIII 29 IE RECEIPT DATE By l DATE FINALED INSPECTOR A.— INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade 7 K. -C 0Return Air Steel Combustion Air Roof Deck (f / Gv Exhaust Fans O.K. to Wrap 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 F'"a BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out 10/ Gid Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final 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) COMMENTS: Aventine Apts 760 777 8773 I s CITY OF LA QUINTA BUILDING R SAFETY DEPARTMENT OF ` ! / 777-7012 INSPECTION REQUEST LINE MAY 21 2000 777-7153 Owne .. """ - - THE SPA_NOS CORPORATION r Contractor! HE -SPANOS CORPORATION -114 Permit Number POST ON JOB IN CONSPICUOUS PLACE pINNSPpEECRTFO��R MUST SIGN ALL APPLICABLE SPACES IVIN-B U Ii.D NOT INCLUDE BLOCKWALL OR POOL TYPE OF INSPECTION DATE INSP. FOUNDATION 8 SETBACK FOOTING STEEL 7• �- .��" i�1�._ GROUND PLUMBING _ PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB c JOISTS 8 GIRDERS ELECTRICAL GROUND WORK 40,11— _ 010'NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING / ROUGH GAS 8 GAS TEST HEATING & VENT - A/C FIREPLACE ROOF l Gv BOND BEAM O.K. TO WRAP GROUT ❑ 4' ❑ 8' FRAMING ..�; INSULATION /— PRE -ROOF o n,r1 zU"l6- Rj 16Cll/ COVER NO WORK UNTIL ABOVE HAS B EN SIGNED DRYWALL INTERIOR /.• %i -,%: / y% EXTERIOR LATH =7-4 �' l POOL PRE PLASTER FENCE 8 GATE R SEPTIC TANK FINALS ELECTRICAL - Cr PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABOVE APPROVALS 00 NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING