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9604-100 (RPL)79090 Arbola Circle LICENSED CONTRACTOR DECLARATION PERMIT# CO BUILDING PERMIT NTR°`# U) I hereby affirm under penalty of perjury that I am licensed under provisions of !!604.1# 316.0 1 6 0 Chapter 9(c;q menping with Section 7000)of Division 3 of the Business and DATE VALUATION LOT. TRACT v cv w Professionalslode;and my License is in full force and effect. 4/181"1C S1g„4i)u.a lD Z D Ch License# Lic.Class Exp.Date r` a U•) JOB SITE APN I\ // 7. " l/, 0,33, ` 3Q13V94 ADDRESS 719-0 0 ARBOLA CIR Cr -ZO /Date v Signature Of Contractor OWNER CONTRACTOR/DESIGNER/ENGINEER T J U rn OWNER-BUILDER DECLARATION MC GL AW ltfli l;'l;PCJOI„; (0 HW I hereby affirm under penalty of perjury that I am exempt from the Contractor's 79-090 AfU3OLA CIR 735 55.HW 1'1,1 i Cn License Law for the following reason: LA qi}'j l• CA %1253 Pnit our.wC Cts. 92260 Z_ ( ) I, as owner of the property, or my employees with wages as their-sole (61 ) (781.X 16 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044, Business&Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals I'Wt,ANUCR SPA Code). N () I am exempt under Section B&P.C.for this reason pt}C;r1&SPti ONLY Date Signature of Owner Ez Q WORKER'S COMPENSATION DECLARATION Z POOL!>,NWOR Sufi 15,5tN1.t10 LS o , I hereby affirm under penalty of perjury one of the following declarations: U-) F2 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. m Q IJ ( ) I have and will maintain workers'compensation insurance,as required by OLO Q Section 3700 of the Labor Code, for the performance of the work for which this IL Z permit is s04,Jd'aMyt}/vku yrs' compensation insurance car rC&tp ol yi o. are: F-s. .1 ,=,r .ren c., n or co .1.a aRoN Carrier Policy No. ob 4 1°1 <HM1'1.'Ffi,%'Sill!'N111A X V Q (This section need not be completed if the permit valuation is for$100.00 or less). 'A ANG#f!:l.a.AFS. 101-WO-439,319 $1ll.1S J O I certify that in the performance of the work for which this permit is issued, r ' '1 ."1'i7t tW f; JN[irl; 1t 1-t Of)-11.8 UI?0 $171-00 _ I shall not employ any person in any manner so as to become subject to the l[X;ii311NIC;AL FEIC--POOL lf3i-(AM-421.000 $24.00 workers' compensation laws of California, and agree that if I should becomet tA.1 CItttC;At.lT)'.--F*(A:.13., 101-fiiMl-420•000 S45.00 e 3 subject to the workers'compensation provisions of Section 3700 of the Labor 1 l.f.J B(N(I f''f .f --1 )6T.. IU!-(00141940) $17.00 rn Code,I,hall fo hwith comply'W. ^those p isions. ( 0 Date: it Applicant - t : Warning: Failure to secure Workers' Compensation coverage is unlawful and I CQ, shall subject an employer to criminal penalties and civil fines up to$100,000,in ( CY , 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 i J 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 SUS' 'l11%11,COIN' )C l'1©lY 113 F'Le1 KIC £1'C!:. $37K 15 any permit issued as a result of this applicaton agrees to,&shall, indemnify LESS PRE.-PAID Ff. S $0,00 & 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 `;1'O•!At,PERMIT fk'EX'S DUE NOW $378.15 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 + I IIIIIII IIIIIIIIIIIIIIIII • correct. I agree to comply with all City, ar d State laws relating to the building 40 construction, and hereby authorize repre entatives of this City to enter upon i IE the above-mentioned property for r ins ecti6 purposes. R RECEIPT DATE BY DA1&fINALE INSPECTOR Signature (Owner/Agent) I Date \i; INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs' Underground Ducts P>•tms&Footings Ducts Stab Grade Return Air Veel 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 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain r Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg.Test ' Final Gas Piping VIV 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 Z Gas Piping Gas Test AppliancesL AA Final COMMENTS: 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) APR-18-96 THU 12 .3 MASTER POOLS * SPAS 6197765889 � P. 03 a-(n <vvCd ,ID� �! - O f All: �Ilk- or Lu ci J � Am.