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0312-243 (SFD)79820 Amalfi Dr 0312-243 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 725£34 B . $GI^N £tt'3lDate -494 Signature of Contractor( a 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 REPUDIC: ffli7l~1 1'NIT' Policy No. 1569160.2 (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 Labort Code, I shall fortwith comply with' thoseprovision s' Date: l t Applicant A&V `1 - v 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 representativ,es of this City to enter upon the above-mentioned property for inspection purpooses.,j y J Signature (Owner/Agent)i '" -- Date BUILDING PERMITPERMIT 0312••243 DATE VALUATION p9q +)' q LOT TRACT Z9323-1 JOB SITE ADDRESS 79-920 A.A!CelL M:. JE2IVE APN 609-380-023 OWNER CONTRACTOR/DESIGNER/ENGINEER PONDk:A2.C)SA HOME H, MC. PC WDER✓ SA NOM U INC 400 9, FARMLL DIiI IE, ISI'— B3 03 4.00 N. YARP;C,S.,1., DR SU:17 B 103 AA IMM'S CA 92264 -PALM SPR.JNOS CA 921,62 (703)15? -710 M40 2346 r 11111111 VIII III VIII IIII 60 USE OF PERMIT SNfi:I, FATJ.tF 'f D J.' .TM40 IE SI='D R J,0T 77, PLAN ?GXR. PERMIT DOES NOT INCLUDE BtA-)CK WALMI, POOL, SRA OR, DRIVEWAYAPPROACH r."Ito P.EC UC111ON TO PLAN CRECK FER DUE TO MULTIPLE ISS I.A,NCE OF SAME PLAN TYPE TUCT CONSTRUCTION 21538.30 Sty PORCH;PATIO 310.00 SF GARA011GARPORT 671.0-1 SI° N.1111MMM CON1111 OF CONS= t'°` . O 172,402,10 CONMUCTION FFX .101-000.418-000 3i Q5.00 P: CHECK FEr?, 101 -WO -439-3113 $106.22 WC HANICAL *E 101.000.421 -OW $103.00 ELF.,C` RICALF1EE I01 -000-x120-000 $144,25 t'I..1.MM,'? x.40 PEE 101-000.419-000 $108.50 STRONG MOTI©N FU - RESID 10)-0004A1-000 $I?.%A ORA.IyIMG FEE 101000.421-000 815.60 DEVZLOF1SR, !MPACiT FW.X2,405.00 -MM C:ONSTRUC'1,riCjt+1• AND .-?LAN CFMCK. $3,92-38,21 MV PK1--P.AC® F 1=1 $0.0 ?. F11"Aum. )?`1 K i IYU I-y'C+W sn'qual f 08 2006 CITY 0; LA C,L'I., in FIIMAkCe DE's+: RECEIPT DATE BY I DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROV S MECHANICAL APPROVALS Set Backs Underground Ducts _ _ Forms & Footings Slab Grade _ Steel r Roof Deck Ducts Return Air Combustion Air Exhaust Fans _ ,_y/ O.K. to Wrap F.A.U. Framing Compressor Insulation 4 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 47 Drywall - Int. Lath 07L Final Final I BLOCKWALL APPROVALS steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING AP ROVA Gas Test Electric Final _ Waste Lines z Heater Final Water Piping of Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 14 Encapsulation Gas Piping 71 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: I..., - ` v V