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0309-044 (SFD)79760 Amalfi Dr 0309-044 LICENSED CONTRACTOR DECLARATION I 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. Date 752S84a":I£. r Date -4 Signature of Contractor . A J'A , J 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 A policy no. are: Carrier Policy No. REPUDIC II f)k,M'Aif' f is:'Atwtit (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 chose provisions., /D'ate: ,• 'r; u, i,Applicant 4r;/d .i, 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. IMPOhTANT 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. I, ! f Signature (Owner/Agent) +%.>9 d , i` R ti- * ""' tQate 10 r` "L 01 BUILDING PERMIT PERMIT# DATE VALUATION LOT' TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / EN INEEk 1?ONlr MOSP. HOMES ES MIIC. IACWbn08*A M1<.WFV if IN C, 61511 0INKPOURNU 4.00 0. FAKOR t L D . MIT .3 I QJ r1_E.c' 8AN'JX_)N CA 94588 ;PAI-iml 0tti Q1?.M c. USE OF PERMIT f o - - -- is x.7rt,4 1T , r IYAR's Y l 1' JC1T VII I I VIII IIII 46 i a SIPD - t. T 74, PI... 14 3bi..--:P:.9RMIT IDOL:; NOT INCI,k 021, SLAYe:Y C: . S 'l0 P 3:1C 'C"I Itis' rs WAU. -,ko% PQOCh fWA OV.,X, i' .' APPROACH. PLAN %3.iTfrk i. ryi3.f aCE: OF SSI; I'l P I 1'YPf 'TRACT CONST iCT'I01T V:r31X(; IIIA il!tjjpp •[[(( RCHaPA.TV :iryi0.t00 sSr 4))J. '4J!'+,ti JC.JF^i.11E :!➢l.l L ©J,V ell' I V U7I't AMI COS' OF OOaitie`a('Jle'yJ'C"T101IN IVE 0 /i37i M, P I PC?h! XMI,Y C0NS'PR': M014 9i'M 101.000.418-000 t94011G PLAN i:HEC K' FEv-'It U1_000 -4:M318 HIr`CHegN WA!,, FRE 101-000.421.000 W-MOUTlYJOAL F E PLUMBING HE 101-000-4,19-000 STRO140 MOT'IC N FftF — R'SS.ID 101-000-242-000- VVLA INOla` E Sr3I-t)OtT 1«i2cT>7 $?.S.tG JDF?-'I►fsi.17VFI: 1MiR}!'.I;'9: tIM2 j{+, l.+I", ; i . %µs'A'i•J' =i+ !':'%a 0 Cf,t IDL,= 1 TMAL SA, W(3 OCT 2'2 2003 CITY OF LA QUINTA FINANCE DEPT. v RECEIPT DATE BY D I E PECTOR ' ( INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALSMECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings A 11 11 Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap - F.A.U. Framing Compressor Insulation i Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation _ Condensate Lines Party Wall Firewall \ Exterior Lath Drywall - Int. Lath i Final Final _ BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines (/4 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 00110, 411 Sub Panels c Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: