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0307-220 (CARPORT) LICENSED CONTRACTOR DECLARATION BUILDING I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT OV1 t'-220 I- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT TRACT ,+p 9' 04 U Professionals Code,and my License is in full force and effect. 1 r S,?3,C 283 36 License# Lic.Class Exp.Date o ILLJ O r 184-531 B C-� HIC rl i10 JOB SITE ADDRESS M-87:4�4�°'�I'ik)IF 47,(31-ARAM.Vtt? APN :'�4�•< ! :?�t4♦ Z � Date f 0 Signature of Contractors--•^� - �� .A OWNER CONTRACTOR/DESIGNER/EN INEEFi CID O orl- � tCYH ROEL 0,01,MEX.T,Cc3N CO.,��IC, J U CIO OWNER-BUILDER DECLARATION 1.5116.f3132.MM,31ZiS'Yr - 784401 HaCiI A.Y:t 11 AS IA QT7'W1TN0A97TW LU Wd I hereby affirm under penalty of perjury that I am exempt from the Contractor's 3,Jk QUINTA CLQ, 92253 $.{lN DIM40 C:'1, 97,'Utz-ot U) License Law for the following reason: (619 :Zr-4.156 f.:SIL i 300 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). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed GARAGE OR CA w?O.riff contractors to construct the project (Sec. 7044, Business & Professionals _ _ _ _ M��-• Code). f. NL.1. KW� tis. �W J .l D•w c:)f�.e)!v) i,R2 .f a..l�. tl.rr•rr V4.+p co () I am exempt under Section LO B&P.C.for this reason N Date Signature of Owner O � Q WORKER'S COMPENSATION DECLARATION o Z I hereby affirm under penalty of perjury one of the following declarations: O,p,RA01/C"AANDLIT OWN SO Lo H O ( ) 1 have and will maintain a certificate of consent to self-insure for workers' X U compensation, as provided for by Section 3700 of the Labor Code, for the O _ Q performance of the work for which this permit is issued. CD Q U I(ti)r I have and will maintain workers'compensation insurance,as required by O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this rn H permit is issued. My workers' compensation insurance carrier & policy no. are: .,t Z Carrier Policy No. VAfC1.Oft 61.4 )ik WIVID CIO.' XI OF COVI$1-NI1'Ci" ON 06 a FAUM FOR a xZUk J (This section need not be completed if the permit valuation is for$100.00 or less). (1710 iSTRUCZ ION K"I't 101_001 -41 18"000 52411,0+0 ( ) I certify that in the performance of the work for which this permit is issued, PLAN C''f{)CK_'Ft'M Irk M3 9 I shall not employ any person in any manner so as to become subject to the E1,EIC11"€ WALMX 1o1-0100.520.000 IMISO workers' compensation laws of California, and agree that if I should become a'.•1!ft ,40 MOT,KDN FE It,,R.CS11.) 1031­000-'241-6Ua $2,31 subject to the workers'compensation provisions of Section 3700 of the Labor Cls:IPa£?4';�t FEE03."X00-42,41LOCC $13100 Code, I shall forthwith comply with those provisions. Date: 4 °T- Applicant /Warning: ailure 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 SM-1-M,Iat. 0D11SS�"t".WtX''`i 0) -ANDM,,llr'TCaDECf,,,- whose request and for whose benefit work is performed under or pursuant to , F _ 7:51a.9 ):h"JE'»ml!}x�;['.F I},0O 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. ' . VE ,. 2.Any permit issued as a result of this application becomes null and void if '1CCyAIG!�` � '`� '� � 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 1 - _ I IIIIII III I I I III I IIII 67 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, -- IE } the above-mentioned property for inspection purposes. RECEIPT DATE „BY DATE FINALED INSPECTO Signature (Owner/Agent)¢ ---- ^� _ Date •,J! _ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE TINSPECTOR 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 17 XT3POOLS - SPAS BLOCKWALL APPROV LS 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 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 HE /1" 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)