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0007-0119 (POOL)LICENSED CONTRACTOR DECLARATION U I he.eby 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 CN W Professionals Code, and my License is in full force and effect. �; D ch License # Lic. Class Exp. Date I-QLO I LU � '� 777601 C53 , r ,6413012( r -Z � Date-, `�� � Signature of Contractor l� �,' • : . C.00 J U CID C:) OWNER -BUILDER DECLARATION HUj I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) 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). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ce) () I am exempt under Section B&P.C. for this reason N Date Signature of Owner ON 0) Z WORKER'S COMPENSATION DECLARATION C:) Z I hereby affirm under penalty of perjury one of the following declarations: U-) Fa- O () 1 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. _CD Q U (!) I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this L LO Z permit is issued. My workers' compensation insurance carrier & policy no. are: CarrierJEsX MPTI�iN ON FILE Policy No. ao � �a 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 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] should become 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions_-�� Date:-� X'1 �!/ Applicant e,/ .. , , ' , - -� - .. ` Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspec�tiompurposes.. �-- -- Signature (Owner/Agent),�'i- �� Date - BUILDING PERMIT PERMIT# DATE ( VALUATION LOT W07 119 TRACT S2.'S,CsW.ttO JOB SITE APN ADDRESS , n A.F .DP:N - OWNER CONTRACTOR/DESIGNER/EN (NEER LARRY SHERMAN CAI.NL'V POV1.,:3, Ik4+:l 78-450 ALDEN 70.180 WJNI)L?R ROAD 03 LA QUINTA CA 92253 RANC110 MIRAGE CA 92270 (760)831.0860 CBI -41 3733 USE OF PERMIT ISL ANDIOR ED 'A POOL. .SPA ONLY•ALARMS/11ARRIER ;FIALI HE IMPLACF AT PRi? PLASTER INSPEC'11014,P001, F.QUII'MFNT ifNc'.Lt I.W Iw W.)T I14CLUDK) IN THIS PFRMIT POOL AND/OR :I PA 131400.410 LS KS'l111IXFED COS -17 010 CO.I'VYl lICT.t OW PF3MI:`1" F'FY 9UMMARY P)4AN C1I13l:R FEF I0I.000-439.338 510.03 CONSTRUCTION FICC 101-00041$-000 'i3.'s,q.50 MLCHAMCAL 1•'EE -- POOL 101-000.421-000 $24.06 FI.ECTRICA 1, PEr - POOL I Co I -00-420=004) 345.00 PIXIMR1110 FEB -- POOL I01-000.419.000 $27.00 SUB-1WAL CON'8T23UMON AND PLAN CHECK X522.53 IMS PRE -PAID FRIM IIIIIIIIVIIIIIIVIIIIIII 43 IE RECEIPT DATE BY -'C_./[" JJ -DATE FI ALED INSPECTOR . 000 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 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 BLOCKWALL APPROVALS Steel POOLS - SPAS 61. a oo Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric 3 m Underground Plbg. Test 451 Zilt I CIO Final PLUMBING APPROVALS Gas Piping Gas Test Electric Final lo�� 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 OD Gas Piping Gas Test Appliances Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels :Exterior Receptacles v-G:F.I! Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Final COMMENTS: Building Address 78-590 Alden Circle Owner Mailing ' Address 1021 VMst�rjchury City IZip ITel. Contractor Address __ ty lZip State Lic.I City ,, & Classif. �,, �-^ !-/ Lic. # P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Arcn., tngr.; Designer Address Tel. City Zip State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1,66m licensed under proviistons Of Chapter 9 (commencing with Section 7000) of Division 3 of`the Business , Prfe slbns Code, and my license is in full force and effect. 14 7 �y � S/'!%i1f.� i..Gr . • ./-/.ate %.%% _.t:✓? f SIGNATURE+'"' - "� �' H•'•` / `DATE OWNER -BUILDER DECLARATION I hereify affirm that I am exempt from the Contractor's License Law for the following reason:/(Sec. 7031.S,Buslness and Pio/esslons Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000).of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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, Buisness and - Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such .improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) 0 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does pot apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ❑ 4 opy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. Date Owner NOTICE TO APPLICANT: if, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Iagree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date Mailing Address City, State, Zip No. 07835 BUILDING: TYPE CONST. ' OCC: GRP. A.P. Number Acacia Ho> Legal Description Tract M68 Plan C-3 Rev. Project Description Lot 103 TOTAL ''Z. IV REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR - Issued by: Date 514/90 Permit Validated by: Validation: IIIIIIIIIII JJJjIIIIIIII 44 IE Sq. Ft. 1927 Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $1059733 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical 114.47 Plumbing S.M.I. 7.42 Grading Driveway Enc. Infrastructure 2137A. 94 TOTAL ''Z. IV REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR - Issued by: Date 514/90 Permit Validated by: Validation: IIIIIIIIIII JJJjIIIIIIII 44 IE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS SLAB GRADE �� 2ND FL. SO. FT. BONDING "ARD SPKLR SYSTEM POR. SO. FT. ® MOBILEHOME SVC. BAR SINK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS CAR P. SO. FT. GAS (ROUGH) DRAINAGE PIPING WALL SO. FT. OTHER APPJEOUIP. DRINKING FOUNTAIN. SO FT ® TEMP. POLE URINAL ESTIMATED CONSTRUCTION VALUATION $ GROUT WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SYSTEM WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH E R(AUTO)(DISH) APPLIANCE DRYER FRAMING GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED S� ( 7 pa I, s (7 LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ®c BATH TUB SPARK ARRESTOR SO. Fr. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL LATHING SO.Ff.GAR ® V4c HOUSE SEWER MESH GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR 7 f SETBACK GROUND PL BING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE �� ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCKSTORAGE / FOUND. REINF.7/ /�J�+J�/ C' I !� GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ —plus—x$_=$ LUMBER GR. FINAL INSP. C� S �8 FRAMING FINAL INSP.t�1�/)Z2� n K ROOFING .�^ — % S� ( 7 pa I, s (7 O'd REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL 4 P.O. BOX 1504 Building 73-590 Alden Circle 78-495 CALLE TAMPICO Address LA QUINTA, CALIFORNIA 92253 mr. &Firs. Young Mailing Same Address City Zip Tel. La Quinta, CA 92253 345--6613 Contractor Enbody Construction VIM Box 4 4 State Lic. City & Classif. H 350656 Lic. # Arch., Engr., Designer Address Tel. Cityipr State I. ,' A I Lic. # +41 0i LICENSED C0J ffRACT R'S DECLARATION hereby affirm that I am licensed unQd-r provi lo�sQf C�tapter 9 (commencing with Section 000)` f Diviojn ��f h Bus ness and(Protess�oh-s�Cod and my license is in full force and .r V .� OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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, Bulsness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or lmproves thereon and who does such work himself or through.his own employees, provided that such irnprovements are not intended or offered for safe. If, however, the building orimprovement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) (kensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. ,Company ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. . CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE (This section need not be completed if the permit Is for one hundred dollars ($100) valuation 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. A te Owner OTICE TO APPLICANT: ff, after making this Certificate of Exemption you should become bject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. . I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter the above-.. mentioned property for Inspection purposes. Signature of applicant Date Mailing_Add No. 14321 BUILDING: TYPE CONST. OCC. GRP. A.P. Number Legal Description Project Description Patio Cover Sq. Ft. 466 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $6,198.00 PERMIT AMOUNT Plan'Chk. Dep. Plan Chk. Bal. 558.50 Const. 90.00 Mech. Electrical Plumbing S.M.I. .62 Grading Driveway Enc. Infrastructure TOTAL 149.12 REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR _ 8 Issued by: Date ermit Validated by: Validation: V661 5 45 ` 0 IIIIIIIIVIIIIIIVIIIIIII IE CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM BONDING MOBILEHOME SVC. BAR SINK POR. SO, FT, ® SEWER OR SEPTIC TANK GAR. SO. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF. DRAINAGE PIPING CAR P. SO. FT. HEATING (FINAL) OTHER APPJEOUIP. WALL SO. FT. DRINKING FOUNTAIN SO. FT. ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FINAL INSP. LAUNDRY TRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ® c BATH TUB FIREPLACE SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® IV. c SEWAGE DISPOSAL SO.FT.GAR ® 34c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE ' FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING 1 i� V FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. TOR'S SIGNATURESIINITIAL5 GARDEN WALL FINAL Ev v�jr-, (b 4I � S � Ev v�jr-, of