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9808-213 (BLCK) LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT# CONTROL# U) I hereby affirm under penalty of perjury that I am licensed under provisions of 990*213 H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION tu,(rar►.no LOT TRACT 8 O V N W Professionals Code,and my License is in full force and effect. v v License# Lic.Class Exp.Date Od ADDRESSJOB SITE i��'EN1JE 48 7 � r J � r� �• OWNER CONTRACTOR/DESIGNER/ENGINEER o ZO � „Date � o , Signature of Contractor I (D i t It, T 12: 1 C;'JJ'r 901 ri l l�D .447x.17• 6 r)A 0 L,<.7 f�flAl4 i`r�r It-r(f-At I` I— OWNER-BUILDER DECLARATION u.c.s. .• ,.e,. r- P.O. BOX 1710 79-295RANCHO NCHO LA QUINN%,DR. W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's aCA QUINT"A. CA 92253 LA QUIN'I'A (_'A 42253 License Law for the following reason: Z ( ) I, as owner of the property, or my employees with wages as their sole (76(1'1771;-1941 i~13(,16 2..91X 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 or..`JI kA1,4flJt(,t)ltUl; contractors to construct the project (Sec. 7044, Business & Professionals i Code). ZPX)L.F.,0 PI RM1.011 CSA% [V.N WALL,ORC O Sk'tii M'IADAbtS S.f. ( ) I am exempt under Section , B&P.C.for this reason LO TQ I)LINE b A;.&IS Ri).} PAW I C\IN Date Signature of Owner 0 C 2 1998 d Q WORKER'S COMPENSATION DECLARATION o Z I hereby affirm under penalty of perjury one of the following declarations: � y Lo Q �r�.WALL ^ 1(It�,Gt?�, ..ITY OF L� IN p ( ) I have and will maintain a certificate of consent to self insure for workers' �lJ 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 U ( ) I have and will maintain workers'compensation insurance,as required by OSection 3700 of the Labor Code, for the performance of the work for which this j U Il u') H permit is issued. My workers' compensation insurance carrier & policy no. are: It Z Carrier Policy No. ; oD ry5 ISTIATE.FIRN1,11) (M0 9S I.!N1'.i'f9K)7 '::T PERMIT y p t��y f 7�` 7� RE `T».1� i�iTED C'ON"I"�.'F�"tJNST.R.I I' �.ON �17�Odt(:.t,,* Q (This section need not be completed if the permit valuation is for$100.00 or less). O I certify that in the performance of the work for which this permit is issued, s;Y:NS9.RVC:1`t0N VU-7s I(tt-U(1tf-41 t► V) �45u.tiH I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,`arid,,agree that if I should become subject to the workeys'compensation provisions of Section 37001 of the Labor CAB, I shall forthwith comply with those provisions._7 Date: f f lf'Applicant rr Warning: Failure to secure Workers' Compensatio, overage 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 "012-'1'ti�i'F�t,t (�IVti`1'Itl.lf"t'f( N ANO 1�3,E`,r�d 4;k; 4'"I� 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. L,i.:S> T"liil-I'r1Li)IrISI:� °wt ©0 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 TOTAL 11CH;V IT FK1Q%DUE NOW $459-51) permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is I IIIIIII VIII III VIII IIII • correct. I agree to comply with all City, and'State�laws relating to the building 48 construction, and hereby authorize representativels of this City to enter upon IE theabove-mentioned property for inspection purposes - -- i RECEIPT DATE BY D F ALE INSPECTOR ySignature (Owner/Agent)` ' t �� D --, t /ru74 ,. INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts ' Forms&Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans&Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall-Int.Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg.Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K.for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice(Gas) ELECTRICAL APPROVALS Temp,Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp.Use of Power t r Final Utility Notice(Perm) 06/15/2005 10:27 7603685719 Yuur+u t1V11VLCIS111k;' ;Dr- 11111 Jill 50 IE ;0"VC1rt.F lC r:.S •• 804 Vlflltloat Dr. Irtt Oo Vie.d22i1 �. --- (7891 S8�$ 7'0 . 130619 Jane 15, 2005 Tont Hartung Building Official City of U, Quixrta &Adams. 3�atercolors Proaecte f'tans 1. 2 and 3., .Ouirata , Dear Tom, We have performed Structural Observation per C.B,C. section J.,7 Z for the above referenced project and find it to be in General Conformance with the. approved City plans and calculations. Please note that this letter does not relieve the City or the Special Inspector.,,from determining compliance with the approved plans. If,you have any question.e please call. Sin rely, f Jeff y B. S. j NO. 40/4 ���' IIIII�I�I�I�II�VIII IIII 51 IE YOUNG ENGINEERING SERVICES k760)360-5770 fax (760)160-5719 77-8o4 wildcat Dr..Ste.C,Palm D-en.Ca 92Zt t June 3,2005 Tom Hartung Building Official City of La Quintat Re:eMarket Rate 11 wir -48 &AdamsFkns-1 2.-&.Guest house La uia Caw Dear Tom, We have performed Structural Observation per C.B.C.section 1702 for the above referenced project and find it to be in General Confornnance with the approved City plans and calculations. Please note that this letter does not relieve the City or the Special Inspectors from determining compliance with the approved plans. If you have any questions please call. Sincerely, Jeffrey B.Young,S.E. QRpFr=S SIC't, B. y