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0008-019 (RPL)LICENSED CONTRACTOR DECLARATION t. I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencinq,with Section 7000) of Division 3 of the Business and Professionals, Codet� -Ia my,Ci&ense is in full force and effect. License # , Lic.'Class— Exp. Date ky 533670 B / ate'f w9G 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). O 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 declaration's: () 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 per of the work 'for which this permit is issued. My workers'. compensation insurance carrier & policy no. are: Carrier L�OLoEN moE. - Policy No. NWC :322n. 1.04 (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 3.700 of the'Labor Code, I shall forthwith comply with thos `p.'rovvigions./, bate:' �'© Applicant ��"� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up'to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and 'restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at�w whose request and for whose benefit work is performed under or pursuant to any permit issued as a resultof this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application'becomes null and-void.if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection/purposes i nature (Owner/Agent Date+ BUILDING PERMIT PERMITN DATE VALUATION LOT' TRACT JOB SITE JPN ADDRESS 51•-890 AVEP%t,I A MORA OWNER CONTRACTOR/DESIGNER/EN (NEER ib3 KKK T{3'C LIL. ; =NROSE C'.ORFO A17ON' 72.850 SOIa ER ROAD 39725 GARAND 4QM M912 0 , PA1M D& .ttT CJS. .92211 ;ALM DESERT ; CA 922144 (7150)345.7186 USE OF PERMIT PC) OL jAXDJOR SUPA 275 L.P. 3't$ 19 L A 4'H MARDEN NVALI. - 01 Y STA140ARb.'13001, t ' ONLY NO HEATER-ALAIRMSIRARRIERS SHALE BE IN P1.4,0,9 AT I'Ii.i? PLASTER INSPECTION. POOL EQUIPME14T 21Ci.t5SilRC� i5 I114CLUi E-0 POOL .E4ND/OkSPA $500.0 L9 "NA 5 IrT. WALL, 175.60 Lif 41q. W..0311, 20.44 L EST)%UT_1W COST OF CC?,N's15fa'UM, 101.4 7.75 . . FObliM. T°UP SUMMARY KAN CHECK FEE, 101-000439-3 18 $105.30 CONSTRUCTION FI?B 101-000.418&000 $162.10 ELECTRICA.I. I+I�' - POOL 101-000-4210>7000 145.01) PLi,tMB1110 119ir ,• POOL I01X0o0-419_000 $17.00 5 SUB-17MAT. CON'MPUCT1014.1N:i7 M AN G"`1:31YCK $339.30 t i:Fs'W 'E R -P, AID Z' US' $0.00 + e t .G,OTALf 1 Sh.�B��`�.E.E %i :w 'O6I.;.I ROW L^a,'•1i:�n�1.' , RECEIPT DATE BYf _! DATE FINALED INSPECTOR 17 . INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set 13acks Underground Ducts Forms & Footings Ducts Slab Grade Return Air Stell Combustion Air Roof Deck Exhaust Fans 0. 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 Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain ( l Bond Beam Approval to Cover Equipment Location Underground Electric d S7 Underground Plbg. Test FinalGas Piping � Gas Test PLUMBING APPROVALS 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) 31 � 3 WL - 7662