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RER (0008-447)LICENSED CONTRACTOR DECLARATION I here '*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 478689 B 021: 9/2( 6, - Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contract'or'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). 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 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 CIOLDEN EACILP, Policy No. . WC W41401 (This section need not be completed if the permit valuation is for $100.00 or less). () I certify that in the performance of the work for which this permit is issued,. I shall not employ any person in any manner so as to become .subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700of the Labor Code, shall forthwith comply with tho$-e1provisions.. Date.'"' G'- 0<2 Applicant 11+ Warning?Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100;000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such i permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this, City to enter upon the above-mentioned property•f r inspection purposes. r Signature (Owner/Agent)"' bate-Jf BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT . I I i"ry c0 IUd7i? JOB SITE APN ADDRESS 814 IS Hag..LA.01.01. 10W OWNER CONTRACTOR/DESIGNER/ENGINEER ).40P EM,Mns 1I, LLC ROGER CM(f HOBB8 501 M.fiJA 53-487 wOUTIOM4FMJX SUN= FL 33477 LP.Qt)WA CA 92253 (7.60)569.5612 CYDL# 5487 USE OF PERMIT 'M REMEXT At,. REMODM 'NO'N4VFIY.VC;:f tJ AL INTERIOR IMPROVEMENTS MOi:M TO ID ESICIId CENT -ER AS PER MUP d#2000.226 . M .. ♦�tt a typ ttS . .... e4V' LUA i IOfY a7y®[,'iJ.ydl I's EMMA= C09r OF CUNSTRIIC". ION Flrl�:t32i'I' Fes; f$'fY . PLAN C BECK FEE 10)-000-439-318. CONSTRUCTION FLOE 101-000.418-000 W.00 MECHANICAL FEE 101-000-421.000 EOM ELECTRICAL KE IM -000-420-006 $41.4 3 T R.4' 140 MOTION FEE - REBID 101.000441.000 RM -WEAL AL C:ONEMMUC, 1ON AND PLAN CFi � CrK $198.05 LESS PRE -PAID FUZ $0,00 TWAL F°3Mgf MIS DIVA 1VO1� �19it.i9�5 RECEIPT DATE�t ` C.,J BY PQ DATEFINALED';:' 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 & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 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 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 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. 1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: VA:17, acvLz> _ t D6° LANPWAPE WALL . rl- _ Y412'WIDE• My OTHM it �• ��a 5� l•1v�• SEAT �'t ' �I� ' raQgr�a��t 7a� S fsgars Mrg z�'t a • f` _ ' r I Y�,��c tai 4�Yrs ��°.'a7••�'T `'recti 'i.d4 {�i ' $ ' , y r t ��I I+K«I^�x�i;. �ai A�.�l. y'�} �, r'yrt„x Y' 4 t t•�cS, �; y�.u�, ''i � r; �•�y /� '�l i., ,p �, , 9-0 ' !c4S++'G{e.: ��G,`••c«Y�y.#I .etr 6° 0 BI-PA99 + r r; •y. a. �A {h �� Q a •• � � s;, r • � �� , • i I fia.; X44tg tt f t ' on Naa ;..-$7t d t !+f iy ✓ n y7i(�AE .r k �' 1 y1 ° x�y�t � P;* "q..? 'i.Y C♦` . n t -'r: *. i ,r �t'•�.�TS'S "ti, `,d } , t " .y.. • I i ft e-aeF�t 4 µ�, - — y Y - ^ moi. { �I ay tH ,rr©•ka•«+�_,�'{.y,E o'x. �r,$f1�:i k�, M,p1. I.t' a .. .+ i. •n...!,: .� I �"'6z�° 5 "� • `P +Y.�i y2 S��i����'�Y�''ti` : � 1 + '"7p � ®"�"' o .' �fifr��� .>�'� l'"o-F�; �.'�l,iw! •.fit n '�` a r � , Nj 6 1-10' '-2• 4'-2`.9M SLAB PLAN 1 20'-0' FOR DIMENSIONS - •� ..+ }�• " - > , 4 SEE EXT. ELF/ fFOR ' SOFFIT HBTS-TYP. - h 1 WOOD 6 TC a . • - - Y. , SEE EL `r •- otorcourt ' ecru ru•LL t � 90 i .1 - ., - " r � c : zy , • .. 12'CW WALL - - — • - ` ; ;:, , t• w LLONADE p - SEE EXT. ELEV. POR ` PLAN SOFFIT H6T9 -TYP, 17= 1f ul�-AR'14 ; f�;'LANDSGAPESaLPTUREDWALLLOW WALL m' G8� rase m C ; m9 i f rte` • �. • .. ' -. • of i \♦"'�" + 4. m ♦ 1 ,.W 1 .. r IIE-- LINE OF j • I OPTION } '+ ti }di 'A���!r � •,#�'�n pry �!! 4 P-2 idr.'� 1^/ `y'Iist'�`"' y. J •. r f _ r I I = f r"' o + (�i r �aYia MM y�,.0 •;ai°Lf3t �C % .l.. . LANSGAPE WALL I I �,: • l..:n r Cjur'+1«. •9d9yr�'fr' 1 . k BY OTHERS --� AR, 3y 5Y^. ,� .12'-B• U - 2'-b° .4,-6°,1 FLOOR PLAN 2 SB ^ * 7y V f w� r -a -V 14CCCSstciL"T retvr- ko _ oasPEat1 01A ICA t