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9807-269 (SFD)I— CV C/) W O =) M �p� ' w� o Z r CD 0 J W I;n Z ch LO N ON U_ (3) d Z LO laIr — O xw�L- M < O rnH It Z ob 5 O 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 Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARAION 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). ( ) 1, 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. K 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. CxOL DENI.E..+• ALE .CNS. N WC 544068-fX) (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 sut� ect t the/��^�torkers' com ensation r vl's10 sof Section 3700 of the Labor ¢ode �a1G : ; hath comp ly7wli4h pNi"�S-- Dai. Applicant`" G 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. :y IMPORTANT Application is hereby made'to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on liis r application.t 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. tl�e above-mentioned property for.i , svection purposes. I Signature (Owner/Agent)e—.Z- 76atez/�� PERMITS-fi'Mi'4 CONTROL# BUILDING PERMIT DATE VALUATION $116.747 ) LOT # TRACT �1,7 as 4"1 , i. B SITt�. ADDRESS %JelllJt fiJ°P" � a'r APN 604,375^010 OWNER` CONTRACTOREER DyjE�SIIGNE�iR(/jENGIN j�� ( y� 07 [ (� (p� ( ( NU�s Is"� :':d,r }. I't Cf,'01Y� 1PLW CO1V".7.1Y7�.7a�� UIvES (/ �v {� {� I�� w� CENIR1 ��fAi✓VA"i.,4 1.O��1.ib�1+.Jt,'iVr Ae:w 1535 SO, 1`011 MEET, S C'.E. 000 5u. "iik� l.'Kf .ir �', gm 11400 SAN PERN.ARDl•NO CA 92408 S�A�.y��At�:N� 1d(:�•�N�(nAPLANNO CA 92�iIf.8 �]]i3((�1 %y� f m) -i 1 S'.'kao /7 CB110 21.20 USE OF PERMIT S NOL,:E FAMILY D WP1,I.11NG SFO, PLAN yAc?, i f rr J.Ct, PERMIT i' i?C?1 S'Nv't .TRCI.tJI)E 13LOCIK WALLS :3R IXX)L_ ,t�LAt�1 %" {i:i:l fr L""^ 1tI JIJf l id 11Y i 4`bis c7i21v1t7L'i 3.PL} 1 iS(7AW E 07F SARI- P1rAN '1)'1*1F. 2�`+.�ii2�iyf; °1001.(0.(10 3r.' C� JO'1'+itS�'�1'.€eC..ipi+;'TION /r .00 3F �.;Xf INATED C0:5T OF CONSTRUCTION .116.,767.40 sP,1i:;lZli' T .FEE SiJi1H.1l4XAN' CONSTRLICf1014l-'!:13 101-000-411-60 $6991W PLAN C193CK I -T -FE 101 -WO -419-318 $146.55 2,4KC'HANUCAL FEE, 101-000-421.OW 547.00 :t LE TRICAL FEF 1111-000420-000 $t.26.oi3 e?`1.13.t41fF31NG F.0i 101-000-419-000 $172.00 STRONO N40110N FIT - RE19'113 101.4000-241-W.0 a 'ADI:NNi, FM 10.1-000-423-01111 $20.00 MI MA$'X' UC TURF FEE 225-000-443-342 V,627.'27 Alltr 1N'1Y %LIC PLACES - RESID 701-000-755.000 541.92 t , LESS RREWW FITS $0.00 o1 V1,T1`1NOW SEP 2 �3 ��:,:,► ,� -, a� L1t. �+ .1: ! r T i "1'ti/ RECEIPT DATE .' . BY D6 E IjJA E INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms &Footings ���� r Underground Ducts Ducts Slab Grade �p - - Q ,� 3 Return Air Steel _ Combustion Air Roof Deck /- 6 - Exhaust Fans O.K. to Wrap fk, F.A.U. Framing 9 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 APPROVA S 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 Water Piping /© .P •C1 Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection _ !n •�=/ T Pool Cover 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 l r Final Utility Notice (Perm)