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0402-039 (RPL)Lr --- 1171 Cl) N to 04 W O M ('y u') W ~o Z 0- C:) H (� W w I— a rn Z co LIDN OQ � U CL — ,0a0 QJ J co < O Il rn H Z oo 5 r -p LICENSED CON.;RACTOR 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 # Lic. Class Exp. Date Date } `� r S gf Signature of Contract r OWNER -BUILDER DECLARATION C 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). ( ) 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 STATE FUND Policy No. ,229, 019797-12.005 (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 3700 of the Labor Code, I'shall;forthwith cdrriply with those provisions. (� } Date: I l i Applicant u _ 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 rompensation, 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 property for inspection purposes. t f � , Signature (Owner/Agent) Date 0- BUILDING PERMIT PERMITN c DATE 0,2, MMM VALUATION S12,0MM LOT TRACT JOB SITE ADDRESS �-445,�i,V.Iu�1 ,'A E.A'F,1Ri�.er1%A APN .. OWNER CONTRACTOR/DESIGNER/ENGINEER Tf1G1Ls+1AS B171,�'N DAM L. ADDI 01'014 P, O> BOX 134 41-7801.1F-M1`�itf�,f?E i�+7 I,,AQUINTA CA 92253 BMWU;?ADIRVES CA 92201 (760)408-7528 MIR 3 724 USE OF PERMIT P0011ANIVOR:1P k POOUS'P.Ai .ALARK411/8ARMERS SHALL 13t 114 I1I..4kCX AT f?R&PLASTFR' 114OPECTION, BLOCK WA:LI IQU1PNi ;l: T ENC:L010URE IVOT C11C 1,111DED IN THIS 1'1:11:M111. 2001 C13C. POOL ANDIOR SPA 12,601►,n0 1.a 1'SiTIM91116 C 04W 0r OOrdfi (T (TION 12,W0.00 FE,TM('1' 14TE SUMVE&IRIr PLAN CjHECK FEE 101-OM439.3.18 187,75 C014STRUCTION RE 101-000-418-000 x$135.00 ELECTRICAL FEE, -- Foot. 101-000-4-20-000 943,00 PL111k BIND P7E — POOL 101-000-419-000 snob MECRANIC.ALE -- POOL '101<=-421-000 $24,00 . D ° FEB 05 1004 CITY OF U1 QUINTA FINAIN-0 DEPT. SUB-T'O'TA'L;CONSMUUf1101iAND PLA3 C"ITEC: $318.75 " I.F 3 M-PATED YHES $0.00 'r`SY.tA.i.. PXR- MI. YM 1C+UE DOW 188 /5 'a r1 RECEIPT DATE c { BY DATEPMALED ' NSPEST09 OPERATION DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS Steel POOLS - SPAS _ Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Finaf Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation _ G� Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: io M 8mm' �' � ` • w I • IM _ NIC" POINT - _` �! MIN. / TYP. ` • I ------ AG _/ / M Q r• NO Le06 nuYl s ©.ylt, .Allpyd WNpa � o L,... lo" S'13�o�kw�11 W r I I I .I n • I AumKkzu hG � I I. M 8mm' �' � ` • w I • IM _ NIC" POINT - _` �! MIN. / TYP. ` • I ------ AG _/ / M Q r• NO Le06 nuYl s ©.ylt, .Allpyd WNpa � o L,... lo" S'13�o�kw�11 (0 a4• G n.G1�OhM It • �. • • • r A s wo sltuJlt\\. _..- - - CA 1 71Kb DBf•M� r 6BTBAGG CITY OF LA QUANTA BUILDING & SAFETY DEPT. _.._.....�=a. APPROVED FOR CONSTRUCTION DATE Z '° BY 4 A&Aje.r�l` / �w�H �crrANc� �s �" socIATEs; INC. THOMAS BuITIN - pm. •f I n . AumKkzu 1! LLP -... •• - i .1 I I : _ PORJER FIANCE. `�`CIAXFJ M ii..N a r• m.•. I ... r«r POWM �-MANCG Mo.m'�$r INC. ...._- l 11110HAS'AUFFIR.-I io. I �:iH.:.1�_ II� • O , S /U 14• pON pU1'I P401tlDM'1 •s tr�O � '�; �� A/AWANf1rT i' ►qN(' (0 a4• G n.G1�OhM It • �. • • • r A s wo sltuJlt\\. _..- - - CA 1 71Kb DBf•M� r 6BTBAGG CITY OF LA QUANTA BUILDING & SAFETY DEPT. _.._.....�=a. APPROVED FOR CONSTRUCTION DATE Z '° BY 4 A&Aje.r�l` / �w�H �crrANc� �s �" socIATEs; INC. THOMAS BuITIN - pm.