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RER (0203-199)77465 Loma Vista 0203-199 '796459 BMCI j 06130tic Date? '' ' Signature of Contractor✓ ✓`/ f OWNER -BUILDER DECLARA40 I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. M workers' compensation insurance carrier & policy no. are: Carrier STATE FUND Policy No. 22"20023566 (This section 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 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 subject t?/the workers' compensation provisions, , of Section 3700 of the Labor Code,I hall foAwith comply with.tijose provisios. » Date:,t}% 2"Z/2 Applicant Warning:"Failure to secure JNorkers' 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 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 & 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 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 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 the above-mentioned property for -nspeetion purposes. f r Signature (Owner/Agent)S f l l.w w ^- Date 112),' BUILDING PERMIT PERMIT# 0203-199 DATE VALUATION S2AW.0C1OT TRACT JOB SITE ADDRESS `17.4 1,C)MA V A APN OWNER CONTRACTOR / DESIGNER / ENGINEER Cil n-49 SIMNSON M143014 DEMEW ISNT 17.465 LOMAT IFF 44-306 NTSQ0n7e DR LA QUINTA CA. 92253 1N.M/AitMMILS4 CA 92110 (760)773-4487 t ffi 6645 USE OF PERMIT `(} t j' A y (gyp y+S S:.EJS.L ,R : O1YEL+ r:.tA :.r a sv r ! s x '.ra s xt rr o ..,.rrrzd•. xi»t. vl.ats✓a4rr REPLA(M 1':1111 NO MdUYTHATION WITH CfWS 01.1VK (SAME °JdxL[3.A!' H 4100,01, LS V 5y''1': t!► ,E!MI 61 OF C }I`iS'Mtfir, 17ON' 2,M).0~t yyyqyy7! , $$ '' ,,yy [(,. [jj 'p / k 1 .T41CR'liT1 .V RCA 4illPi;{iIL,fRR ELECTRIC.ALFRE 15 P1.iiMt3tNG HEL 101-000-419-000 $21.C!O PLAN C K FEE 101_-000.439-:316 $35,110 C ON yTRdCT10 ? 10 000-41 0 SiXt 0 15 MAR 2 U NO2 - MAMMA FINR >i A 8W1`C► SAL C()Ail':3'1 VIC'1`T01,i AVD I- AN Cl `M - K $126.85 TOTAL IPFMN=FEES DUE NOW $126.85 4., A RECEIPT DATE / ✓ BY DATE FINALED INSP§ -W I 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 •QZj Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 1 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 Water Piping 16 Heater Final 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) e, (N) 2X8 WAil TO REMAIN MUST BE EtED "SUITABLE FOR LOCATIow 6f91' -GLASS BLOCK ((fdj N -MOPPED $HO R PAN _ H Sw (}tN DOWER BENCA O NEW I HOW(R (Sr- C51x*vk ; i r s (N) TLM D SHIOUV9` ENCLO URI; {E) E. sAf{ HER BATH ; v r EXISTIN BATHROOM! 1 TO REMXIN (ELECT,MECH.) I % GFI FLOOR PLAN NOTES 1 1: WATER PROOFING AT ALL SHO'AERS TO BE DOW BY ROOFING 00WRACTOR, 2: HOT MOPPED SHOWER PAN SNAIL BE MPECTED UPON COMPLETION OF NOT MOPPING AN SmA BE FILLED WITH WATER FORIHSP6CTYDN.. 4 USE WATER RESISTANT GYP. BOARD IN TUB AND AND SHOW R AREA TO A HEIGHT OF 7V ABOVE DRAIN INLET. PER UBC 807.1.9. 6: nLE LINED TUSK & SHOWERS SHALL CONFORM WITH AMPO STD.. 2.82 & 4.B2. $ ALL `OR EQUAL' SUSSnTUT10M MUST BE SUM MTTED AND APPROVED 9Y THE CITY BUILDING OFFICIAL PRIOR TO INSTALLATION OF THE ITEM. vi I i1 C LASSWC — T .VES I NG ' I I 4LA QUINTA ' B I DING & SAFETY DEPT. POa@' E R CONSTRUCTION DATR -3 Ito OZ BY d FLOOR PLAN 1/4-I,A. r SHf[T A2 EXISTING YWW TO BE REMOVED EXIST940 TUB & YLR TO BE REMOVED W t, i ' DRESSINGL -i ' I • (E) TOI I I i HER BATH EXERCISE (E) BI FK DEMO PLAN rRa . .f RNpp16 BY O 1 fl C/1 L c s"1 -ET Al