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PLBG (0104-272)BUILDING PERMIT, PERMIT # DATE VALUATION LOT TRACT 04124=, X1 MIN) JOB SITE APN ADDRESS 1"05 A)MMDA. MAk"VAM0 OWNER I CONTRACTOR/DESIGNER/EN INEER Mr ,f @41A. MARRAZ0 52- M 5 A! M.Mls HAMM= .f -..A QUWY.A. Q& 92'e"W4 USE OF PERMIT .B., L, WILSON BAUKHOE'URRVIC' P.101 BOX' 1660 IM0 CA, 92202 06112�)347-6946 CM.4; 2417 S1t.P,PTfC-.AT3A)4 DION - Sii' tR. C014TIF-CTION7 CONTIMCT AMWNT I'sno'.00 w xsm"na) cosm 07'r co -ma -RITC -Roll PRRIm. I'm WMMARY KAUMBING VIM - MMY-1Z 101-0,15GA-19.000 $30,00 A APR 252001 CITY OF LA QUINTA FINANCE DEPT 1. KIWAYI-AL MKIMMMON NWD KAX C14-RZ1e I LISS Fkl�-PAWFWS TOTAL M, UMNFEES DUR TIOW RECEIPT DATV tiif V/04 BY I DATE FINALED IINSPECTOR LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of � n 3 of the Business and Chapter 9 ((�I.jmmenciQ ng with Section 7000) of Division C4 W LLJ Professionals Code, and my License is in full force and effect. M License # Llc. Class Exp. Date,, 1* Cy Ln . T - 529319, Alit 6Z I, Date Signature of Contr.,i^r/ 1 , t' or F (D OWNER -BUILDER DECLARATION LU LU hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z 1, 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). C13 LO I am exempt under Section —, B&P.C. for this reason 04 Orn Date Signature of Owner CL < WORKER'S COMPENSATION DECLARATION '14,2 Cr Cr Lo <, I hereby affirm under penalty of perjury one of the following declarations: 0 O 1 have and will maintain a certificate of consent to self -insure for workers' X LL1 LL compensation, as provided for by Section 3700 of the Labor Code, for the 0 _j -J1 < performance of the work for which this permit is issued. - < U ( )" I have and will maintain workers' compensation insurance, as required by d -L-) S4otion 3700 of the Labor Code, for the performance of the work for which this CiU-) a)H permit is issued. My workers' compensation insurance carrier & policy no. are: IRt . Z Ob 5 Carrier Policy No. 3TAT3.t RIN I) J$0984W < (Thisx 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 Pshould becolw suoj'ct to the workersycorhpensation provisions of S ction 3700 of the U Codb, I shall forthwiffircomply/4th those provisions._ r Date: — 'Appli6ant,� 4- Warnlinq-�—Fa`ilure to secure Workers' Compensation covetage is unlawful a d k_,.• -shall subject an employer to criminal penalties and civil filles up to $100,00), in addition to the cost of compensation, damages as provided for in Section 706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Skely- 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 I - construction, and hereby authorize representatives of,this City to enter upon the above-mentioned,property for inspection purposes. igrfaftG-re (Owner/Aggn! BUILDING PERMIT, PERMIT # DATE VALUATION LOT TRACT 04124=, X1 MIN) JOB SITE APN ADDRESS 1"05 A)MMDA. MAk"VAM0 OWNER I CONTRACTOR/DESIGNER/EN INEER Mr ,f @41A. MARRAZ0 52- M 5 A! M.Mls HAMM= .f -..A QUWY.A. Q& 92'e"W4 USE OF PERMIT .B., L, WILSON BAUKHOE'URRVIC' P.101 BOX' 1660 IM0 CA, 92202 06112�)347-6946 CM.4; 2417 S1t.P,PTfC-.AT3A)4 DION - Sii' tR. C014TIF-CTION7 CONTIMCT AMWNT I'sno'.00 w xsm"na) cosm 07'r co -ma -RITC -Roll PRRIm. I'm WMMARY KAUMBING VIM - MMY-1Z 101-0,15GA-19.000 $30,00 A APR 252001 CITY OF LA QUINTA FINANCE DEPT 1. KIWAYI-AL MKIMMMON NWD KAX C14-RZ1e I LISS Fkl�-PAWFWS TOTAL M, UMNFEES DUR TIOW RECEIPT DATV tiif V/04 BY I DATE FINALED IINSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS yet 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_ Sewer Connection _7 Zlp O �j 7 Pool Cover Encapsulation Gas Piping Gas Test Appliances Final Final C/ — 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) COMMENTS: " FROM FAX NO. � � Apr. 24 2001 07:18PM P1 ' � u ".-,.` � � toAC*gLL^vm.Lc,wAT�eDISTRICT CASH neCcprnsWL -^--"~~ � n^nm,w,r�" � 1 Tract --_-----'---- . ' Address: _ Account NO- ��^�o� _��_�_ _ ..= _____ -______ �'~" ------------�� aam/^w*/________� � 13u"u/uw(5)__-__---__-�____-_� 7 *ousemteral(o) Detectol Ch^ux(^)�---'-�-�--------------- --- �' MeterSurcharge 'nc��°cxvn�o�o -- -----_ ________-----_ ^ �� ` ��nrnuv'm^mwa,--_________ 0 r��nwn� ' n Tom'on�xurn^ - wamo -__'�-------�� ou^oo/��vu^cvo"^t ' __ Fem'_----- � wv�,/�e°=� �. �p�nCx�x Trac t� -------- , ' A.D. ' __ao»«--------' { u aonupn�n" `' _-- O covm��,�epoox~__�_________ . ' Cin*e,-_---- . � _--_--------__'__--__- w"te,m°r'o° ------------ � oodp'w: o"� `V", _�/ , ' \ `