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RPL (0403-247)49505 Loren Ct 0403-247 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that`I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division -3 of the Business and Professionals Code, and my License is in full force and effect. ' License # Lic. Class - Exp. Date 656118 C 3 WC C=8 0l3Ilot r Date •Y/ Signature.of Contractor d' r. OWNER -BUILDER DECLARATION" 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 SeVion 3700 of the Labor Code, for the performance'of the work for which this permit isejsg eO.CMno ke rscompensation insurance ierr,&& po y no. are: Carrier Policy No., (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 to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions 'Date: *" Applicant 7 /,, V / - 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 tlie-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, 7 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 ins-pec tion purposes. Signature (Owner/Agent) `fes % '/ o ? Dater PERMIT# PERMIT .Y r ,BUILDING DATE4' `'__­_VALUATION S111,0010.00 LOT 40 TRACT JOB SITE 2yet 4.9-:05 LOREM COURT - APN - ADDRESS OWNER CONTRACTOR/[ / EN (NEER i A tiFI `:Y1' vL1 FC' 7 iC + C:AL%RiIR:let`Tl!► POO &. SPAS -Wp mml CCJI 9968 IMBETT':l 'Si 102 86-100 AVM' k 54, SmDWCC) CA .92131 COACH MLA CA 922M, (?60)398.9222 CIBLO 60 55:5 USE ]OF LPET. IOR►S'.PA rfnfl l AVTN t?PA 'A k f) A' q.1 . 2.10 AicTTI1RJ , X°A;A:4ltIaiVT:T4VV''. SHA t, U.P.4 PLACE PRIOR TO R1x.1 P TER INSPECTION, FOOL FQFr3Piv ENT VNICLOSU 1.E NOT ITIC:I..UDED W-1 P&tML'T. ' POOL AND/OR 91% 17,000.00 LS 3&SI t4WfED COST 91' CC9NMUMICflN 1,1AN CHECK FEE 10.1 -000-4394118 < CONS 1 RUCTIOM IMF, 1 n 1-000.41 9-000 V180.80 MECHANICAL FEE 101-000-21.000 DilECHICUIC A1. PEE .- POOL. 101-0010-421w000 $'ti4.tt9 ALEMTRIC.h;, Fi0, --1001, 101.000-420.0010 50,00 P1,i1MBINO 'PEE -POOL 101-000-419-000 SUai-a'CYI'AL C©a3,c;x`!21J(mmu Am i?tw- C -A wx, $393.00 LMS PRE, 13AED nW $0100 .tom ' r r' - •y. . . V {i 'v E= ..x.311.00 1 MAR 24 2004 _. CITY OF LA OUIN „A FINANCE DEPT. , RECEIPT DATE r?w=' l BY DATE FINALED INSPECTOR 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 BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location y Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final oF Water Piping Plumbing Final P imbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final — 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) COMMENTS: