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0008-0152 (WALL)47750 Adams Street LICENSED CONTRACTOR DECLARATION 1 -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 Profdssionals Code, and my License is in full force and effect. License # (HE'91ass Exp. Date t Date + a Signature of Contractor 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 exclusively 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. () 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 C1sVX,1l00N AMBRI Policy No. I I KROD23246 (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws,,of.,\California, and agree that if I should become subject tolthe workers' compensation provisions of Section 3700 of the Labor Code, I,shall forthwith comply with t ose provisions.: Date:.'' t :2/ A Applicant',f($ 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 upo the above-mentioned property for inspection,purposes. Signature (Owner/Agent) ; _ + Ai Date U BUILDING PERMIT PERMIT# // DATE j 3/0 VALUATION LOT 'J-02 TRACT JOB SITE ADDRESS 47- 7.5ADAMS RIMPPT APN OWNER CONTRACTOR / DESIGNER / EN (NEER 111E E MOS CORPORAnOX (10MMY 331~•V LOPMM. 1341 W. RC%I31N1100D DR. 117434 HOLLY DRIVE 9.100crorg CA 93207 1?ONTANA CP. 92335 (909)82,3.1175 CBVt 05201 USE OF PERMIT C1•I AI. E 'l.;O'A"'i tC3 (i 30 L.F. 6H- OA .DEN 111ALL (TRASH HNC WSURP,) &(42) 18'x W 5'H COLUMNS (24 001. PL+I IME 1 RR 18 POOL ARRA W1 WROWHT IRON ''H TWEEN FACH. 62 LF 6'H 0AROLM WALL CYH R1:`I`AiNINCI) 61sT. WALL 210.09 Ix s FT_ WALL 63.00 LY 4 FT. WALL 65.00 LF x7r11wr9j.) COW OF C01491217f°1 on PE.RWf FEE SUMMARY -- CONSTRUCTION RL 101.000.418-000 O_ °.. CYN O Q 0 v; `-3"UR-`,t'U.r.AL CONSTR MO13' AWr) PI..A►A] t -'T (wK, M IMS ER£-PAXIMU TOTAL P—MY—IT FIETS WE 1 OW LA0 II III I' I I II IIIIIIIII . 39 IE RECEIPT DATE I BY+rZy- DATE FINALED INSPECTOR I/ A. INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE TINSPECTOR 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 F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final 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 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: TRASH ENCLOSURE DETAIL Typical of 7 301.f. of 8" block waff,City standard design DETAIL SOLID WASTE -AND-- RECYCLING ENCLOSUREQ N.T.S. z I u -0 36" OPENING 8' BLOCK . WALL. 6' HIGH . 4' HIGH CURB 6' THICK CONCRETE SLAB N $ 24" 00 N 6'0'X5'-6" N 1 TRASH/RECYCLE BIN (TYP.) I 6'X6' STEEL 42 1/2' WIDE POST W/ 2' METAL GATE (Tl P.) DLA- X 3'-6" DEEP CONC. FOOTING (TYP.) 00 DIRECTION OF TRAVEL OF WASTE HAULER 6" THICK CONCRETE APRON DETAIL SOLID WASTE -AND-- RECYCLING ENCLOSUREQ N.T.S. z AVENTINE APARTMENTS SDP 99-654 Masonry Wall Permit - — See Landscape Plans for locations _ Wrought Iron View Fence 730 L.F. (24 columns) DETAILS B & I Pool Area Column& Iron Fence 326 L.F. (18 columns) DETAILS B & I Retaining Wall 62 L.F. DETAIL H Trash Enclsures (7) 210 L.F. Trash Enclosure Detail COVERAGES CERTIFICATE OF LIABILITY INSURANCE 03 DATE IMM/DD/YYI 30/00 _.Ea THE REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pao MAY PERTAIN, THE INSURANCE POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE (7 6 0) 346-2480 LIC . # 0 C4 8 6 9 9 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR CRAIG DAUGARD INS. BROKERS ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TYPE OF INSURANCE 44-100. MONTEREY AVE. #206 INSURERS AFFORDING COVERAGE PALM INSURED DESERT, CA. 92260 GOSNEY DEVELOPMENT GENERAL LIABILITY INSURERA:CLARENDON AMERICAN INSURANCE CO. INSURER B: 17434 HOLLY DRIVE FIRE DAMAGE (Any one fire) $50 '000 X COMMERCIAL GENERAL LIABILITY INSURER C: INSURER D:CLARENDON NATIONAL INSURANCE CO . MED EXP IAny one person) $5, 000 FONTANA, CA 92335 03/30/00 03/30/01 INSURER E COVERAGES POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING THE REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH MAY PERTAIN, THE INSURANCE POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSR TYPE OF INSURANCE POLICY NUMBERDATE IN MIDDfYYI EACH OCCURRENCE 61, 000, 000 GENERAL LIABILITY FIRE DAMAGE (Any one fire) $50 '000 X COMMERCIAL GENERAL LIABILITY MED EXP IAny one person) $5, 000 X CLAIMS MADE FlOCCUR 03/30/00 03/30/01 PERSONAL & ADV INJURY $1,000,000 A X BROAD FORMS TBD GENERAL AGGREGATE $1, 000,000 X PREMISES PRODUCTS . CQMP/OP AGG $1 , 000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY- AUTO ONLY - EA ACCIDENT S EA ACC S a=�� OTHER THAN AUTO ONLY: AGG $ EACH OCCURRENCE $ EXCESS LIABILITY $ OCCUR FICLAIMS MADE AGGREGATE S S DEDUCTIBLE - - S RETENTION S _ X WC STATU- OTH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY TBD T RY LIMIT ER 03/30/00 03/30/01 E.L. EACH ACCIDENT 5 1,000,000 D E.L. DISEASE - EA EMPLOYEE L61 , 0 0 0 , 0 0 0 OWNER E.L. DISEASE. POLICY LIMIT Sl 0 0 0 0 0 0 EXCLUDED OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 10 DAY NOTICE OF CANCELLATION FOR NON PAYMENT OF PREMIUM AND/OR REPORTING. CERTIFICATE HOLDER ADDITIONAL INSURED; INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF LA QUINTA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3 0 DAYS WRITTEN BUSINESS LICENSE DIVISION NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL P.O. BOX 1504 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR LA QUI NTA , CA. 92253 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE © ACORD CORPORATION 1988 ACORD 25-S (7/97) State of California C�� , 90E" State STATE LICENSE BOARD F Af"" ACTIVE LICENSE License NumbeF518059 Entity I NDI V Business Name GOSNEY DEVELOPMENT Classifications) A Expiration Date 02/28/.2002 ��