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0212-106 (POOL) LICENSED CONTRACTOR DECLARATION " PERMIT# I hereby affirm under penalty of perjury that I.am licensed under provisions of �BUIWING PERMIT H Chapter 9 (commencing with Section 7000 of Division 3 of the Business and L "�� P ( 9 ) DATE VALUATION ,y LOT TRACT N W Professionals Code,and my License is in full force and effect. License# Lic.Class Exp.Date LUJOB SITE r 6561.128 C5 3 01 . � 1 . 1IN ADDRESS 80^• &A,'t%NVk' APN t*- r— OWNER CONTRACTOR/DESIGNER/EN (NEER C ZO r r�Date Signature of Contractor .f � - -• ' o �c.�"�1.431�E SE � C x+ 'T�.uI P001".5�'.SPAS(M.P MW CG^Y30 H OWNER-BUILDER DECLARATION J U co 80-209,fad MM, 3+�5C ^100 A't�XNU;�5rA W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ,,, �, , , ,�� ~ a License Law for the following reason: Ai&QVIVrA CA {a'`253 C'�;p',�'�"�'`Ee�A 92112 36 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 1000LANDIOR RPA p' contractors to construct the project (Sec. 7044, Business & Professionals ` Code). POO'"<1101i'(,I :A 1I a},25 L.F. 5'S;..QCK'fAALI,C1 Y () I am exempt under Section B&P.C.for this reason STANDARD, N Date Signature of Owner std',;1�YtiSY'310 ON C� Q WORKER'S COMPENSATION DECLARATION p Z I hereby affirm under penalty of perjury one of the following declarations: , Lo H O ( ) 1 have and will maintain a certificate of consent to self-insure for workers' '�FT.0 110 29'00 L-S X W � 'compensation, as provided for by Section 3700 of the Labor Code, for the irOC�t'AtL?ffkP'PA �i,4 �'fllf � O � JQ performance of the work for which this permit is issued. M Q'C) (� I have and will maintain workers'compensation insurance,as required by O U QS-ecti�on°�3700 of the Labor Code, for the performance of the work for which this d 0 H permit is issued. My workers' compensation insurance carrier & policy no. are: v Z Carrier k'€.A FF t"���F�133,A'rI Policy No. �#$+��Eti�tR�+�d JUIE ��+. D r+C?�`.C'OF� �1.�' '.{:.&T11 1110-I''� 25,000. ob O prouff te a;SUMMARY g (This section need not be completed if the permit valuation is for$100.00 or less). PLO!CHECK 110 10'1.00'0,4'.49-31.8 $10103 ( ) I certify that in the performance of the work for which this permit is issued, CONSTI RUCT[014 FXX 101-000.415••000 $23,930 1 shall not employ any person in any manner so as to become subject to the 'MSGANICA,f.2�C�`F nOL 101.000.421.000 workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Et.#rC"i C'ft" l I .� tC9L 101-000-420-000 t:5.r10 Code, l shall forthwith comply with th s. provisions. F�C�'i:7l�b13040 FRE PON., 1.9 1000.419.000 Date: g` Applicant— Warning: pplicant Warning: Failure to secure Workers'Compensatio 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 'RUB-!"ITAL C6 TVTEVUM10NTA1 PLAW'6,lrY,ROX 1122.1.5y4 whose request and for whose benefit work is performed under or pursuant to [%CITY Ud,�n 1,,�;�-.�,IAM 1'.G�'R�t.`� x€.,.00 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 1��3�:��.!f 1°zl"l):UPSDUNNOWwork is not commenced within 180 days from date of issuance of such18 10011permit, 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 LA QUINTAI�IIIIIIIIIIIIIIIIII513correct. I agree to comply with all City, and State laws relating to the buildingCE DEPT. construction, and hereby authorize representatives of this City to enter upon,, IE the above-mentioned property for r spection purposes. `7 / , RECEIPT DATE BY D FINALED INSPE Signature (Owner/Agent); T' r,*.. D to✓ `'� �24� f� x rr r+'? 1,'1 l/ 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 Wail Firewall Exterior Lath Drywall-Int.Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel _ Set Backs Electric Bond J Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg.Test Final Gas Piping G/ PLUMBING APPROVALS Gas Test t Electric Final '4 aste Lines Heater Final °Nater 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 _ C 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) IIIIIII I I III VIII III 59 4 'ENo. 1222 . ' P.O. BOX 1504 Building $0-209 Ave 50 78-105 CALLE ESTADO Address LA QUINTA,CALIFORNIA 92253 07e' .th $ease Mailing BUILDING: TYPE CONST. OCC:GRP. Address Same A.P. Number City Zip Tel. La .ltti-xata, GA 92253 564-.4599 Legal Description COW t Reese General Contractor Project Description 335' of 6� high garden wall Address Same City Zip Tela State Lic. City &Classif. B1 15610Lic.`# Sq. Ft. No. No. Dw. �► �...C. Size Stories Units Arch., Engr., Designer New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Address Tel. z4 City Zip State Lic.# LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section e000)of Division 3 o h ,8usines`s•and Professions Code,and my license is in full force and ffect. ` � � SIGNATURE _ DATE; t— OWNER•BUILDER DECLARATION Estimated Valuation I hereby affirm that I am exempt from the Contractor's License Law for the following $8,375.00 reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a ; permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to lila a signed statement that he is licensed pursuant to PERMIT AMOUNT the provisions of the Contractor's License Law„-Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that.he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. subjects the applicant to a civil penalty of not more than five hundred dollars($500). Plan ChkBal O 1,as owner of the property,or my employees with wages as their sole compensation,will . . 1 do the work,and the structure is not intended or offered for sale.(Sec. 7044,Buisness and Const. 3 �� Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, ,Mach. provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burden Electrical of proving that he didnot build or improve for the purpose of sale.) t O I,as'owner of the property,am exclusively contracting with licensed contractors td`con- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for .S.M.I. such projects with a contractor(s)licensed pursuant to the Contractor's License Lew.) Grading O I am exempt under Sec. B.8 P.C.for this reason Driveway Enc. Date Owner Infrastructufe WORKERS'COMPENSATION DECLARATION I hereby affirm that 1 have�a`cert i ficate of consent to self-insure, or a certificate of Worker's Compensation Insurance,or a certified^dopy thereof.(Sec.3800,Labor Code.) Policy No,.- Company CPCopy is filed with the city. O Certified copy is hereby furnished. TOTAL 108.00 CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS'COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line j Rear Setback from"R ea CONSTRUCTION LENDING AGENCY Side Street Setback fro enter I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code.) Side Setback from Pro D LI Lender's Name Lender's Address `} t This is a buildingFINAL DATE INSPE R permit when properly filled out,signed and validated,and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Issued by: Date Permit I agree to comply with all city and county ordinances and state laws relating to building ? , construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Validated by: Signature of applicant Date / Mailing Address Validation: t / City, State, Zip CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO.FT.® $ UNITS YARD SPKLR SYSTEM 2ND FL. SO.FT. POR. SO.FT.® MOBILEHOME SVC. BAR SINK GAR. SO.FT.® POWER OUTLET ROOF DRAINS CAR P. SO.FT.® DRAINAGE PIPING WALL SO.FT.® DRINKING FOUNTAIN SO FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE:Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRYTRAY AIR HANDLING UNIT CFM KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE,TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO.FT.®c BATH TUB SO.FT.®c WATER HEATER MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®11/4 c SEWAGE DISPOSAL SO.FT.GAR® 3/4c HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST.FEE ELECT.FEE SMI FEE PLUMB.FEE STRUCTURE PLUMBING ELECTRICAL HEATING&AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C.UNIT COLL.AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING(ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND.REINF. /�� GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APPJEOUIP. REINF.STEEL GAS(FINAL) TEMP.POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING LUMBER GR. FINAL INSP. cu.yd. FRAMING FINAL INSP. $ plus x$ _$ REMARKS: ROOFING VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL