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SFD (9810-129)57241 Medinah 9810-129 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 13 jo Date Ir) f T 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). d. ( ) 1, as owner of the property, am exclusively contracting with licensed contractors.to'c0struct the project (Sec. 7044, Business &Professionals Code). O k I am exempt u6der Section B&P.C. for this reason Date Signature of Owner 1. 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 Policy No. 0 U :-J$-ilttu2"36 (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 06e, I shall forthwith comply with those provisions. /Date: t Eir c. Applicant Warning: Failure to secure Workers Compensation coverage is unlawful and shall subject an employer to criminal penaltie"s 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 r 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 ate 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 upona the above-mentioned property for inspection purposes. ignature (Owner/Agent) ` ' ZN Date 1 /11 y PERM' CONTROL# , BUILDING PERMIT 129 DATE VALUATIONS ?! S..88,o , ,l1 LOT { TRACT LQ 488, J06 SITE 45.7 1431 e?Jd,N APN 7 ►.✓[-4130- Q26 ADDRESS OWNER CONTRACTOR./ DESIGNER / ENGINEER /Y1 (n.. gg }} Se 4rr v t4iiery. irl rla ^7 v i _i,eI C. ' (( ,' 'i..[•V` s `iet'.f' 4 r; .S,iry •.Ai-0bJC N .I:itir 750 C3 ST EM4 3.140 79-401. Y~''Y-Y.Rf;si44V 1 X4 .t i.( 9N EYt j Go :. CA 192 10 -1 LA QUUNrA: CA 92L53 (7,607-7t-3303 COLA 4972 USE OA F PERMIT pp ` 1,].t :J I'.l iv 4.t irll'4.I.t.IJfv vr 1 7}Yin 1;10, LO ► ffi 3% PJr AN .t A,k'R> WIT TOM N -00T INCLUDE BLWK WKI'1: O.22 1(4 i..a"y.(l%:VR.ii/Eta w'.7 CLQ]i{'Y Y/ClM0p1 y yi'S*rtZUk^,:: C A(LfiCEfCA#si1CU.ftT 56+1.00 SF . 'Pyg +y {9,g E /^g g• e q,g Y7A -'g' y • ifuyrY JF. .Y t'A dtl i A.'.. '6.•i1t,:V.X.''4f'¢' . .ri'.i'CPJt + V !C. ;.11.L.l v pad C s9 (9 t 8 :i4iq.F..YS: I ' Tyy ' + gp' i FF_ 101-000418-000 M-00hi-Al, iG:+Ct 3 1; ti;,FAY tt'.tsJ:( 1;' t••'tlflC- <i'l liCfi2 Sti4b('f O t -t)00 4.20.000 $145.9-3 0XAMINGiyEU3 1t,'Y-Ot3t► 411-(1t€? 3f, r.(!t3. 'r g3 ct A >^in'r17M . ,-:t. :ati Y i ►(H ?.,4'!-O t? $7,st.£s! . fiF,'t:'1:6;s3 2t:iT,' 1:O: .t7!is. 4 . •'s ©;J ", 20,f30. iNFtAS1'JrcUCI.i;TCt'L"° F%Rr. 225 -WO -414.3-3122 b'k,:13.f1 Jk AR`t:' f.N >«iFE L C VLAf lV8.*-.RE '701-(}0i).2 —00() 51220 13 . y wi. t1' • i Ali. , v r' .. ", . , .: 1'x-1=:t't ti AJ C.;Ca i` "! If f 1 5 AND M . :N UI C 3 i 1998 Tal'AL VVI RM1! r VC, V1411 1.3U UNOW REQ IPT E • . BY DATE FINALED INSPECTOR OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade _ /_ / _ 7 l /J —Q 4,L2.1 Underground Ducts Ducts Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap -/ l F.A.U. Framing -p j 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 ZZ 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 Water Piping _ /_ l Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster $ewer Lateral Sewer Connection Z//S/g •d_ Pool Cover 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)