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0111-202 (SFD)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 # ;rt . Lic. Class Exp. Date 11 MC W I Az Y Date 7 a4• A, 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). ( •) , 1, 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�a',RY1113 Policy No. FMse�U4ibt1 (This section need not be completed if the permit valuation is for $100.00 or less). ( )' Icertify 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 agraaee that if I should become subject to the workers' compensation.provlslons of Section 3700rof th Labor Code, I shall forthwith comply with;those provisions. Date:j�54:-) fir^ 1 Applicant r" Warning: Failure to secure Workers' Compensation coverage:is unlawful andl 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 enteyuponr the above-mentioned property forinspection purposes. Signature '(Owner/Agent)�L'' r a�} Datert i BUILDING PERMIT PERMIT# ; DATE _ VALUATIONE�++oo+�!!�� LOT 01.11-202 TRACT � ���',,yc :q-2 +� .J' (. l�r:L',F M,Y.r•+aSr.BJhi ."' i^:� _w 1�i 4I8 JOB SITE APN ADDRESS 7-,-,M :SIGN DYM EAST tA9, 4C* -W2 OWN]ERTT CONTRACTOR I DEI GENdINEER SPAM 4rMMUC dDN 17 10 79-2,95 M4117210 1A QMYrAVX (f )IT11.194.1 Z 0 2996 USE �Oy�F�PERMIT p, •p �•yy 3@@7,,•a�yNG N:L1.�-rppi�!�',qq/•r���pp tLh//iFI.• yy.4J.+g3�.w6G'r'vpaglq {{..''FF ��tt��ii yyyy��•qq ���oy �y qy �� /n�vpv p y P001, SPA OR WRIVWK -ARMOACH CUSTOM WA1LSTRLfC° ION zm'" F POACW'PA.'.1ID 267.00 SY 0ARAMUCARPOR Y 614.80 3F BMW=CO OFaOY911RUCIMOV 2201RIWIM .ABT:Iii.;1G'C.t,1S�A+JAa.Y�+rfmu&Ry 0�:!va3�'�t:t?G"1`10hd1�;.fba 1t'f1,#(3�iY�1�-�!� 31,8g�.d3#i e't:i<Ei;� C".Y7k:1wA': �'•� r Q.�i'.•.f�-�i:�9-•� S u'a' X23 t 9II z 1tia�i :: Y x�t -. xt•t��a MOM XJ=TIRIM, .1+1WR 101-000-420-000 $162.01 PLOOMD1140 M ' 101 -WO-41,9-000 $170.21 S iRcrl. G MOTION F'f.?S b RMID D $01<f 00-241 »000 $Y2.09 (Rd M90 Ful 101.,000-423.r000 $20,00 MYN EILOF'ER IMPACT ME $1,907.00 ikf i1' .PU1 LIC MAC ., USE M-000-4454= S1521113 SUB— i4.3`SAL COM" UCL10Afi 31) k?1.A14 t'�t•�C't� $3,728.38 LK99 FRE -PAM FERS $0.00 .. - R.g."4:y,F..^!dd U"-3, C.CrS7 s e d RECEIPT' DATE it �� • .i .. BY j-%'l.� • D E FINALED — /—©� INSPEfe INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS . MECHANICAL APPROVALS Set BacksUnderground Ducts Forms & Footings � —,Z2 -L-2 _ Ducts _ Slab Grade��_ Return Air Steel _ Combustion Air Roof Deck �_�_ j - L Exhaust Fans O.K. to Wrap F.A.U. Framing ��Z _ a., Compressor Insulation _ Ventsj Fireplace P.L. Grills Fireplace T.O.�j Fans & Controls Party Wall Insulation _ rJ� Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath✓/y'� Final Final 9=�%- DZ, 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 l_?j�rpS Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral —�j� -�� �s Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas)D ELECTRICAL APPROVALS - Temp. Power Pole Underground Conduit Rough Wiring 3_ Z - Z Low Voltage Wiring Fixtures Main Service Sub Panels _ _ Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final - l> Utility Notice (Perm) 05/13/2002 09:18 7607711841 SPARKS CONSTRUCTION PAGE 01 FAX TRANSMITTAL Date:. (. b � Return Phone # -To: 77 � � • ( / .. / From A ioF r ,�- Nat Office Box 1716 Telephone: (760) 771-1941 Fay (760) 771-1841 LA Quiets, C 1ifornia 92253 05/13/2002 09:18 7607711841 SPARKS CONSTRUCTION PAGE. 02 A&M Consm►cuon p.0. box 366 • � QV��� CA 9'°Sa rm) 9G"32 p603 56-&-0406 Fax Frear_ Pages: `"�.✓ V Re: cc; i Phase Reply C Pleas4 RacYCe C Urgent © For Review G Piaese Gam+ t � Notes. ? �i� YA c� t� /4m -kill t TO .3JCd N0110na.Ls100 my 90b0 -b95 -09L ZZ:bT Z007,/01/90