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9609-119 (MISC) LICENSED CONTRACTOR DECLARATION PERMIT# CONTROL# U) I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT 4093 1-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE 9/16/'#6 VALUATION 57,047.20 LOT TRACT cv W Professionals Code,and my License is in full force and effect. Z) cO License# Lic.Class Exp.Date W u JOB SITE ADDRESS 80-21)9 AVf�'.l�ftll~..r�li APN 769-274MIZO �l Z � Date Signature of Contractor OWNER CONTRACTOR/DESIGNER/ENGINEER !L� cO °� OWNER-BUILDER DECLARATION i<1��`T!`�c��':A.ItiD iktEPSE K/ �J4L"`.#i .�3lJ.tl,l EX r � U W W� (0 �t)249 AV'�'NiJ�?501 hereby affirm under penalty of perjury that I am exempt from the Contractor's 9020INDI4 CA 4221)! U) License Law for the following reason: Z_ I, as owner of the property, or my employees with wages as their sole co pensation,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 l�1. Sl. LI'.AY�3tz�.1l1S contractors to construct the project (Sec. 7044, Business & Professionals Code). co (/I am exempt under Section B&P.C. for this,reason .420 LF, g"Wil�ii 11�dCiNt� O N VDate y/�/��Ci _Signature of Owner���, ��.y ±`✓�!� .. rn Li Q WORKER'S COMPENSATION DECLARATION p Z 1 hereby affirm under penalty of perjury one of the following declarations: U-) FZ CE O ( ) 1 have and will maintain a certificate of consent to self-insure for workers' X Lu Y= 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 have and will maintain workers'compensation insurance,as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this 1;^ 11�q j ;l)CO. T Ole'COl'Nti`I RUMION 7,!!47.x1) Il H permit is issued. My workers' compensation insurance carrier &,policy no. are: Z Carrier Policy No. 1'F,Rf01`I 151.f1L1N1ARI' w d C0'NS1I1RfYn.1J d1N MIR 101-000-41940) 5519.(10 J (Thi Asection 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'sh II 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 3 subject to the workers'compensation provisions of Section 3700 of the Labor bode, Ips a I forthwith comply with thoAseBrovislo s. V Date: SV Applicant 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 SLIB.TO'f AL f-�aNgP1�U�-w ON AND PUW CHECK whose request and for whose benefit work is performed under or pursuant.to D IXSS PRE- FR S 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. D { F OTAL PERMIT VM"FA 1)UENOW S".00 2.Any permit issued as a result of this application becomes null and void if 1 work is not commenced within 180 days from date of issuance of such SEP 1 1996 permit, or cessation of work for 180 days will subject permit to cancellation. _ 1 certify that I have read this application and state that the above information is1 g 11111111 VIII III VIII IIII 57 correct. I agree to comply with all City, and State laws relating to the building y construction, and hereby authorize representatives of this City to enter upon F IE the above-mentioned property for inspection purposes. RECEIPT DATE BY a, (� DATE FINALED INSPECTOR Signature (Owner/Agent) � --� Date / � �� +' ':J s 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 0.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 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 Final COMMENTS: Final . Utility Notice(Gas) ELECTRICAL APPROVALS Temp.Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp.Use of Power Final Utility Notice(Perm) .4- -44- � nclio Del So I " owners- kci+> and Wanda Reese 80.209 Avc. 50 �O•lS4 .9vc,Sd 1.4 Qui n-ta., .Ca. 42253 Approx. I Y acrcz scale; ( X00 ' Masanary Plas+er wall fali ien#A or Property r.. Cur. w. r F4t,4rG Rcg. Ramock I Hoary 1OL Nat. t�J�'n• � Et � a. <��) �i `,� �, �,`, '�. G v-4. tF n .,fir pest - fo�pp � -f. i 9 'x...4: /• H ..Fc: �A J•.?'':. L�'' 4. - } !! e'Y a Cpr V rescnt .4 i ,H rf.ZE--..� :'?' C -- rt '.k �,./"J:..• N.z'�.,'ilyb N ?. +..r y............ Tree b5c, i..,i, .• „7( -?Y"_f C�4l!4�+y Ste''?_iK��� `I� �' e� t 4p I tr Q` Pl noun v ; E u taJ QY9Q� manwro s��r Z',: :: j` •1y f.. t.c, L,yg2•�svrl�f.tq�f,,57;9'.�. 'S' '§• ue * J, � `�p� tnC/est�ae R'k4�dl \i MT a..v.N p G11 ru::: y'' moo• 3- v'xaw n: rrxNIPsroragc Rrca �, �' � � ►, ��� .T >�`� 3 Il stall �.; f � f zr.r $ Nortk Arcna „ Eiolfi- �+ JgAj i`'. .``i � _4N_ ��`` �z�y' ` ,�L•r:: LfiNT F`=��^`"�`�. .., �'. . `y'x��� ' ? £i��� 0 [ -.e u._a? eRn;S •. 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V 'c `IM, n y�1 is ;?'u �'• :}3`� 'w,ti x`� lY q' �.. `� :�C� �1'cr `:';' '3 �. �' l'�r 'kr�prl t --•: � '' rt �`. s ...? �L� .�,T't��yexs's�'�:,,L •`�h-r r'�.�� z�'�{�,yr�t''L•y' e r.�:. �itt't ,E• m„Y,''• : -` .0 � r�3�, .'�'��� ..fj�7 ; ♦' ?��F::�W ` Y�: (, l �r� ,jam _ � �15..?•x.x <-�r:i �L� ry�ep-,i, �: - � 4 nr Ja'1 i `"•: ov � ..-' ^y•..; y, �'.U"�/u�-w.-�" c� .�, ."tta✓rt'L,'r'S. ^r+_ xl...,t+< ..n�?*)ski., , y� rte.. e .r •�:+:c ?+_ate s -••^.m+'x „r R..- - -.o:,s -►. ......:ac?:.".a, .t -a1'^ �/� CI K- .ti• i'i .-f :,> Q:-fll w U3 u I c o Ft. w,dI3&eK0 SAFETY DCPARTME Kan law Prrd p. R-I CONDMIMALLY ACCEPTED (�©RMNS RUCTION v SUBJECT TO HSTALLLATO®N AS PER AND ALL APPLICABLE CODES viote; green area ivuj►ccat s a ran and tree zone - ,3Y 5 ,3Y944 bur -face Il y gccoynodofe5 .,��__ - or3eS=Qu" _ =or-ab�v yellow area indicates work areas or relQted to horse activity pj Ak area 1' ,S housing for k or5es