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0302-026 (PLBG) LICENSED CONTRACTOR DECLARATION BUILDING PERMIT . PERMIT# I hereby affirm under penalty of perjury that I am licensed under provisions of Fes- Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE f VALUATION LOT 0302-02,6 TRACT C14 W Professionals Code,and my License is in full force and effect. Ig License# Lic.Class Exp.Date !! d LJOB SITE APN ti W 7:Yti.riS�} ADDRESS 8.1-6€0 A4�. X IX 1f►S.";�'0-€?l Z r- dr ate Signature of Contractor OWNER CONTRACTOR/DESIGNER/ENGINEER (D 0.1, F- 0 OWNER-BUILDER DECLARATION I+dF.°�2Ji�.•1Tt:E2.t�E�I�7�1 D[WRICT CIOC��LF�iW'L�1�1 "FtJ C't7'31ti CID,RX1. H d � I hereby affirm under penalty of perjury that I am exempt from the Contractor's 81.600AVENI P 58 PO 28$ N License Law for the following reason: T-A Qif"I:,TA CA 92253 hal CIN-TR0 CA. 92244 Z ( ) I, as owner of the property, or my employees with wages as their sole �~l caj,"ss m7 5J CSUi 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 C3 ��11. tY4stC3 contractors to construct the project (Sec. 7044, Business & Professionals co Code). 964 SQ.rr. IWASH RACK* STRIJC7'URE U.I OCC. TYPL V-K 100iISTP. () I am exempt under Section , B&P.C.for this reason O N Date Signature of Owner rn Q WORKER'S COMPENSATION DECLARATION D Z I hereby affirm under penalty of perjury one of the following declarations: r H O O 1 have and will maintain a certificate of consent to self-insure for workers' !Yf)WT1hCT OUNT SS�,SEp.4R ' X W �= 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. m Q ( ) I have and will maintain workers'compensation insurance,as required by Q U Q Section 3700 of the Labor Code, for the performance of the work for which this IlLOH ,permit is issued. My workers' compensation insurance carrier & policy no. are: v ? Carrier STATE4YN7� Policy No. f45-N1.1463 1=)N I„ �'b D C®S"Jr Cly'C'O�tSMUL'C:"�"�0H 159=6A0 00 O PERMYr 31'F+X SC.' M ,' g (This section need not be completed if the permit valuation is for$100.00 or less). CONOTRUC ION R32, 101-000.418 000 $2( 100 ( ) I certify that in the performance of the work for which this permit is issued, PLAN CHECK Fa:Z 10 t-000-019.3 1 8 I shall 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 i�LC7XkT2dCiL� a: Q -EYOt7�4lJt $3A,0 subject to the workers'compensation provisions of Sectio -3700 of the Labor STRO40 MOTION WE-COMM 100-000.241-000 3 Code,I shall forthwith comply with tho y�provisions. � :�kR Ypy PUBLIC Yj�,t; 3.COM 210-00, n�300 .t ,,Date: v� _�'�,!>Applicant � _ - GRADI.11C}'FF-F, 1011-000-41,23-000 Warning: Failure to secure Workers'Compensation coverage is unlawful and D n shall subject an employer to criminal penalties and civil fines up to$100,000,in Lnl n addition to the cost of compensation,damages as provided for in Section 3706 E! of the Labor Code,interest and attorney's fees. FEB 2 4 2003 U 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 CITY OF LA QUINTA application. FINANCE DEPT. 1.Each person upon whose behalf this application is made&each person at 31M4` I'AI,C©MMU(1,TION AND PT-AM CM01. whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, &shall, indemnify ims i>Rrj P lj--us •f1t3 & 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 TOTAL'PERWY ji'-M8 DUE"'NOW "14 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. IIIIIIIII=�[ 371 certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize represgntatives of this City to enter upon the above-mentioned property for inspection pu pose ✓' /-" �� RECEIPT DATE = BY ! D ° IN P T --Signature (Owner/Agent'{)'" r' / DatPg.�•,?Y-r�s 1 " 3 OR 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 BLOCKWALI /'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: � Sn 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)