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0401-302 (RER)79845 Amalfi Dr 0401-302 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 752SS4 B 111 1 _ 1lil4 L D4- Signature of Contract 1 I v 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. Se( )/ I have and will maintain workers' compensation insurance, as required by ction 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 Policy No. UPUBIC 3" DUMNIT' 15671602 (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 theLabolr Code, I shall forthwith comply with tho- se/provisions----- Dater )l 0a%- Applicant /1 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 employe 2. Any permit issued as a result of this application becomes null and voi[fln work is not commenced within 180 days from date of issuance of s permit, or cessation of work for 180 days will subject permit to cancellati I certify that I have read this application and state that the above informatio correct. I agree to comply with all City, and State laws relating to the build construction, and hereby authorize representatives o -this City to enter u the above-mentioned property for inspection urposes. Signature (Owner/Agent) Date- f o2 BUILDING PERMIT 'PERMIT# DATE VALUATION .. LOT 0401-302, TRACT % ;? $6121'.c..2K) E1 29323-1 JOB SITE APN ADDRESS 79-845 AltaSA1.-n D%1W-,' 609L.380-023 OWNER CONTRACTOR / DESIGNER / EN (NEER PC)N7.)` K-ROSA 1*S:fJR+.f t -S 11, INC;. PONI7ER03A HOMIZ U INC 400 9. B1 400 y, IMM -1, S TLB 103 +a'3T.M SITZ l IGS CA 9Z264 PALM SPRINGS CA 92e26,2 (703)IW.710 CBIJ. 2346 USE OF PERMIT IIIIIIIIIIIIIIIIIIIIIIIII 67 i2 S:f Tt.42 PF.'.CAl: WDS4CJI E1, IE OPTI6)XA!,, 89DROOMSIt3ATH 4 (+179 s.E' FROM CIARA.CIE, ALL DONE —_- - DURINO I`4MIM, CONSTRUCTION TRACT CONSTRUCT10N 179.00 S1' 1't:swjmnim cos r ov, C' IomS'1'trC:tTe1:1©m 2 -4?D PLAN CHECK s)T0, 101-000-439-3 10 $20.19 CON.17FRUCTION ?1r•I.+ 101-0000 410-060 $gt+.v^U MECHANICAL FRE 101-000.421.000 101EC TRIC,AI, FU 101-000-420.000 = $3.69 PLUNiMC1 FER 101.000.4.19.000 $19.03 STS ONO MOTION PER, • RFSID 101-000-241-000 1.62 SUB-'rO f'AL CC9M3'IttlCriON, AND 7A'1 AtT am, CK $131.49 ZUS FIR&P/y' RPM 50.00 TOTAL POMIC 1,7= DUE $131.49 :F:E!B2 610]04Lq CITU Or LA QUINTA { BY/ /-,.'.Z _V!PZEQ4,W SPECTOR ' U .. 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 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: 3.•