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9806-216 (SFD)U) H N W O �C) ' W o Z l� �0o. H� J W W I- a U) Z co LO N ON U °) Q Q Z LO Q 0 X W L L 0JQ mUU O CIL: 0) I- Z cb 5 �a Q J 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 # Lic. Class d Exp. Date 701019 �H it%lJ9 Date --I/ Signature of Contractor --- �� OWNER -BUILDER DECLARATIION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reasons - ( ) 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 Policy No. (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 --hat if I should become subject to the workers' compensation provision's of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. i5ate: //r Cd APP_licant- _,- Warning:,Failure to cure 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 r 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..- ,iSignature (Ow nedAgent) '�� a-- - �" Date BPERMIT# CONTROL# BUILDING PERMIT v VALUATIONp�d LOT TRACTS217, ®10 oJOBDATE - /I (__-981116-1,16 18 - JOB SITE APN ADDRESS 80.74.9 CEDAR -.RES41 761M490-020 OWNER CONTRACTOR/DESIGNER/ENGINEER MCC©MW-:`. TROX'I OP LLC TFILf1NIS B NEN' HO MSING (NC 730 B S'r 9M 3140 78-401 F HIGHt' AV It ] SAN IYIECK) C`.A. 92101 LA QU#N`iA CA 92,253 USE OF PERMIT `t''.) - PIN 1. LOT 16. ?i ASF 25. .E' !i A I iN S N0T ►.e1C ILUD.E 4LOO. WAl�l,q €:�#: taCiCli�. 1sLt1l� 1'13Et;.'K. }+"fs"1s itfaf>1,1��i,1i�' 73°.ekC:}Q21�AlJ.t,11�+1.t•3 1SSUANC1x rYF r A&P-1RLAN TYM.. + ,•, I �.> ►lJ�`l ��1itirJry ���.t.��'I�.i4��1 `.9 J�.ry.�l�i Al' eUST . 0?.1t0{ft•>A11(J 432.00 3F t:rAE�Ac.1�c:rYft1�J:K'1' f+;fi7.tri) :+1� c,"r:f1'4S'1`ldQ0110N P'IX 1171-000-41h-0011 pi, AN1"ifrf,"? _-ITq Ill4=('N)(7-411)1.318 521539 &11101AWCAt. V1,4s 101-M, -U111-000 3`)l;.xi+) t:Gl-C 1'1t1C.•AL Vlzlr 1.011-00ID-110-000 Sl59.152 P1„1Si1 OINQ 1''1111{ 10.11 -000 -40 -WO $1118.00 N13t0N(II IM(YrIO1 N 1;T-+ - 1t14*`*117 .10141010-241.01110 s2l. S) GIII`AJ-)fN G1:tit: 10141111.421.000 $1,1100 JI t4PICA';116 i+r`.l't 3Kf. 1, 01 22155 000-443,342 4,V 2.E37 ART1N P111sf.1i.:1%Afi:'F3 - #CESI 701-000-2554110 s"I �81.1SY ��i�i 1,3C�3J �1'r�AY,J ). `�14�,L i,s�)Y t1.ty i.�!i�� !�: tii�:til�. :�iirRV3 Q3 'iytSSt 'ii% P�+1rt FUS TO 00 ' JUL 14'998 TMAL DUE NOW x,80.03 RECEIPT DATE �BY/ ' DATE FINALED INSPECTOR 1 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade T --1-3 —c{ Return Air Steel Combustion Air Roof Deck J. Exhaust Fans O.K. to Wrap p - F.A.U. Framing ® — =Z7 Compressor Insulation p — 6 _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath l0 - Drywall - Int. Lath p 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 —/r — Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection (� b= Q�� Pool Cover 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.I. Smoke Detectors Temp. Use of Power t Final— l9tility Notice (Perm) COMMENTS: