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RC (0307-106)78010 Main St Ste 109 0307-106 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 111//:3012E 'Date ' Signature of Contractor "gr' ,•i `i I 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 Section 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 STATE FUND Policy No. 1440125-03 (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' compensatioWrovisions of Section 3700 of the Labor Code, I shall/forthwith comply withAK6se provisions 'Date: V / r p/'_5' Applicant 7'r .'- .-/rr'-'' `° ✓ ' " 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 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 in-spection purposes. Signature (Owner/Agent) Date ice. Lei°d/, f pF-4-,s--` BUILDING PERMIT PERMIT# ' 13307-106 DATE VALUATION LOT TRACT 0.3 JOB SITE g q y, y y • r + ADDRESS .iE l31 1Av C.1C.I, M)MR, C, 109 APN OWNER CONTRACTOR / DESIGNER / EN &NEER OLS TOT_& QU'fN°3'A, TLC 1*MRV' 1✓ .0M S 7i3A0 30 CA1sL.E E9 TAT C 3I.'i✓ :Z.01 - 78.080 C/331E03fif00 S'.TE 7,01 LAQT7TAi`1:A CA 92213 LA, QTJ N7'A CA, 921-253 C760yX714567 ClSL6 34W. USE OF PERMIT COMWERCLAL RYMtyD1:TL COMMERCIAL TENANT IMPROVEMENT • SALON MONTANA, "Et" OCCUPANCY TYPE V14 C010TRUCrION, 2001 c`T3C VAUTA'TIaig I2,"9.00 L8 E5r': 7KID COSH Or COMIS iMUC110M 22,8013,0 PERMIT 11w, SUMMARY f LA14 CHI?:= ME 1©1-000-439418 $9310 CONSTRUCTION FTSE 101-0e0"18-000 $1,44.00 ItiECi.A14ICALrt K 01.000.424.000 $39,00 M CTRICAL FEE 101-000-420-000 $41..50 PLUMBING FEE 101-000-419-000 3600 STRONG MOTION F R - COMM 100.060-241.-000 Irv- sUD.T9 AL Ct71 d9TRXITt:,°T'I C N AND PLAM .- ld PPM -EAU) ' ' 2 SUM pxpmw ms Dux Now AUG 0 8 1003 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE BYe)i 1 i rJ x'7-5 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 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath p 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 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm)