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SFD (9705-022)LICENSED CONTRACTOR DECLARATION 1 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 7,1428.3 f es'' ,, 0099 L,DA�_�Al Iq 7 Signature of Contractor a + j OWNER -BUILDER DECLARATION 1 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. 704.4, 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 S 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 Policy No. ;cUR10.111NS -Co, ,W, 4AVA50 (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' compensatiornprovisions of Sectio, 3700 of the Labor Code, I sha I forthVith comply with those provisions. Date: ,r" -a .1 10j Applicant— / pplicant tv /W ra ning: Failure to secure Workers' Compensation coverage is unlaWf and shall subject an employer to criminal penalties and civil fines up to $1 001 00, 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 5 Dertv for inspection -purposes. s nature (Owner/Age B■ .ILDING PERMI� PERMIT# CONTROL# doom UVALUATION ��1 1Ll[M 1 9 0 DATE LOT TRACT fl'L2/9�«3; 11114 JOB SITE ADDRESS ���I APN ' 7G:�-Ski-+0iI3 OWNER CONTRACTOR/ DESIGNER ENGINEER KC�L IdXND I1 CUR? 01 DRVttPyIWi*TJRP 56140 PPA. Iii,V1a 56140 PGA. BLVD 1.AQt-l'I[WrA CA 92253 LA.IQUIN"1i1 CA 92143 (760)771-3641 CBL# 4676 USE OF PERMIT St�U `:1<i� • ili�2.(i �h(lt . I�Lf1Id �` (Q °•t g �•�2Z f �'q'% F'I.r1A1 t�'tt�<„3vi"fsl� fii�)iJt';!:1) 7�*�`u irf:lit Mt)t, f'1l�Lf? iSSUAiVf`F: CSP' :�t1M1; PLAN CU S4'6* CONS" a RU ,"HON 4655.00 s ►'GRILIVIATIO *_4)2,0 8F Cfr1Tt�1�+ilCrlltl�.j)i'!' 71.�.tff3 .34' 1STiRMED Ct),IT Or CONSTR IC ION 224,315.90 �'�)�P,ri:1'1� i� t!:h:, Sf)[iRA')�#:2`1' "°�, • t`.t. NS"Ct2Ch:7ION 4• T;, 101 -0(h) -418 -OW $ 4 ,u77.t1tt P!, AN (".1TECK ► li4; 101-000-439-113 N16t.`.f1AN1C'r0,l.3= E 1141-000-421.400 141:6.."1'12It'�°�I.1a<a1. 101-000-420-4)W a) PH thalINO r"Ur" 101-(100-419-000 $185.25 C j svilIONQ Fpl? - Ri?SID 101-111)(1.-7.11 _W, 97^. 46 tN4afZAS1(t11C".!'tJ1likhE 2250004�1�-142 9r7,9tr7,98W.Q'' � � ART IN P r4il.l4 PLA(`R3 . AI -'5)1: 74)-O.W-2'5.5-1300 S:ii2 r�i ZE .) yCl.-3CYt't i<C'ONSM11Uf."!iGN;/ AND PJ AN rNJT-K $7,04776 LBSS PRF-)'A(11:,"TFS $0.00 TOTAL PKkNIVIAMITES IMENOW $7,047.76 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs p Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof DgcjL Exhaust Fans .K to W5t F.A.U. -ffafftinr Aga Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final t — - 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 /Q Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Pool Cover r Connection Encapsulation Gas 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 i Utility Notice (Perm) - .�.� `S. ,y��" _. •_ .+.y�.:.+z�-"�r,=^-� ,,.�t•_s.,,,�sF^'�.. �.-r� ..-'w•. ; ; Ki `s'^'Y+.a�-�'.rJ'\..-t,.,("`; �?.�w.r—.c.....*,.,.-r,,.. ;.,,-�..--.r�.-�>,.,.-,-'e �^; ^sem'-••;4;��--^ ,�'-� . ; �.. ' y y= �� �� Q& ON TAN DY y�rCC 5 Condalia Ave. Ycca Valley, CA 92284 ,SPECIAL INSPECTION SERVICE -,•SPF X61'9) 365-5045, REGISTERED INSPECTOR'S'WEEKLY REPORT TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE �TRUCT. STEEL'ASSEMBLY 11O o3 ❑' POST TENSIONED CONCRETE /❑ ASPHALT O OTHER ❑ REINFORCED MASONRY O FIRE PROOFING JO /ft ON REPORT SEQUENCE NO. TY OF ST,F?UC TURE��. A (� �^�� C'j'�,,p JLdJI l6 `!J UIE- i 1 I J &e- PERMIT., NO. QATE I ..�� /CJ DAY OF WEEK MATERIA DESCRIPTION L 0T.�'1 /V RI/T ARCHITECT - IN4 ll of � HRS. CHARGED ENGINEER ASSSSIS�TIIA11tNTTSSI HRS. CHARGED INSPECTION GENERAL.- (' . SUB j DATE CONTRACTOR K� �(/ ,CONTRACTOR s. 4JC' w I #4 e © ,LS E 4SS u&=L0 (N G ' p ' j C.a�JtJPCc( otJ IA-r� Vt/ Lw ` V 7 COPY SENT TO CLIENT '" CONTINUED ON NEXT PAGE ❑ PAGE OF !� CERTIFICATION OF COMPLIANCE i I HEREBY CERTIFY THAT I�HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE, NOTED._I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF, THE GOVERNING BUILDING LAWS." ��IGNATUWOF REGISTER INSPECTOR ( a DATE OF REPORT REGISTER NUMBER