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SFD (0205-030)50060 Malaga Ct 0205-030 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. Dateeeyyp r yy 53, 167 0 '.7 aft ,Date yj% / Signature of Contractor 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. Se( ) I have and will maintain workers' compensation insurance, as required by ction 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are:. Carrier OTATE BUND Policy No. 0711a2 (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," Iw ih those provisions. "` S ,✓ Warning: F ilure 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. I 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 inspection purposes. Signature (Owner,Age t);' Date77 .- /'i PERMIT # BUILDING PERMIT DATE VALUATIONVO7s $` .'aI3 LOT 226. TRACT 30125.1, JOB SITE ADDRESS ` 160 IVULAGA. (340M ,r APN TW3_ ,32_021 SED 4:)13AHOMES, 11ZC PALM D-RSOU CA x,221.1 .USE OF PERMIT SMILE FA1A1JY.TYWrJ2,bTG SVD d WT 26 PlAbl 2.. RVItIMI9' DOZE 1u+ Is001, SPA OR DRIVEWAY A['MO At.°.H CONTRACTOR / DESIGNER / ENGINEER SUN—ROM CORPORATIUAI 177-645A CC. MO J`i X ( 2LUB :LtiPOR 37 ifM, fi 60)772.-1122 Mu. 1137 ,! ORC:FIl.I'!S'f'IO 12 -14,00 .5? 0A, UF:C:.ARPOWt 663,00 SI: •V1•43Isa'I.'11. C ©YTitic.` 1rJ1 I 1►:9i'! I .i,LSP.Y r`74 Rnxc°MATED COST OF CO tNSTR 7Mf4 S .a - 03 2 2002 1:1:.;341 P.I' I-PAAD rim J CV49TRUCTION, FI,1✓ R7 a00t3 I €I C C1 J ja0,1; : 0 PLA14 PI EV.X FEE *819:A0 MECHANIC AL FFY, "A 01.000«421-000 b i t pioo 'V1,FC;`.TR.IC..AE.Ft a 101-000.420-000 r PLUMB440 IOI Cy30ti4'1` OOr9 16Ff 130 S T RO1211MCITION YEE = "fto,IO 101- D%0-241-.000 IV 2 0.Im GRADD10,67,01 101;,000.423.000 $.20,00 010V ELOPER IMPACT FEE ART IN PUBLIC PLACES -: U.9ft. 270 -OW -445-0010 SIMI$ g ' •V1•43Isa'I.'11. C ©YTitic.` 1rJ1 I 1►:9i'! I .i,LSP.Y r`74 ;6,x 1.t1 7 .a - 03 2 2002 1:1:.;341 P.I' I-PAAD rim J $0,00 C1 - OFLAQUINTA F7NANCEDEP6 r ;RECEIPT DATE -:],;By 2.713 ff' )l DAT'EQFINALED 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 c9 Z Compressor Insulation — Vents Fireplace P.L. Grills Fireplace T.O. Q Fans & Controls Party Wall Insulation v 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 Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines?. Z L Heater Final Water Piping Plumbing Final Plumbing Top Out Shower Pans® Equipment Enclosure O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection ', GNU _ 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: