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0404-056 (BLCK)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of -I-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. O M Licensed�!:Cp� ��r,J ryI�i� Licc. Class Exp. Date LLJ l�Yt T! ll_B CS Pli a t397`�{ii2�C r .,.C:) Z r Date r -� ,�f Signature of Contractore'`��/(�'' CD J U C _ OWNER -BUILDER DECLARATION W W 1 hereby affirm under penalty of perjury that I am exempt from tlile Contractor's ~ U) License Law for the following reason: Z_ ( ) 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 N Date Signature of Owner O0 Q WORKER'S COMPENSATION DECLARATION CL C:) 2 Z I hereby, affirm under penalty of perjury one of the following declarations: O () 1 have and will maintain a certificate of consent to self -insure for workers' X W �= compensation, as provided for by Section 3700 of the Labor Code, for the O J Q performance of the work for which this permit is issued. m Q I have and will maintain workers' compensation insurance, as required by d U Q Section 3700 of the Labor Code, for the performance of the work for which this a rn H permit is issued. My workers' compensation insurance carrier & policy no. are: `t Z Carrier 3')',ATE FUND Policy No. 103616-02 oo 5 �O J (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with tho e provisions. y�Date:'� <-111,/Applicant Cl s Warning: Failure to secure Workers' Compensation overage is unlawful and shall subject an employer to criminal penalties and civi,fines up to $100,000, in addition to the cost of compensation, damages as pro. ided 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. P1 Signature (Owner/Agent) A SAA Date t BUILDING PERMIT• (PERMIT# ' 040.4-0 DATE 04X3r 2(a VALUATION LOT TRACT I JOB SITE + APN ADDRESS 78-560 MGRWAY . I I _ .. OWNER 1 CONTRACTOR / DESIGNER / EN (NEER OM-M:£"IIIN LA %UM.A :.LL 71-084 TAMARtM LAKY, RMCE10 Cl—A. 92270 USE OF PERMIT 40 LF 6' BLDG" VTki L PER CITY ST CDU.4�I'PROVED PLANS -2001 CBC, DCD DEV, WC dba DEMURT Ctrrs.. DEV. 78.600 HIGHWAY111 Lal'!. QtTA A � C -A 92253 (7 60 771-3345 CBII# 2180 40,00 LF PY.Rdl►l1rr TKIZE SI ¢a IRY - - CONS' RIUC:TION FU 101.00-0.418.000 MM D a APR 0 5 2004. i CITY0,F LA QiiENTA MB-T'J' TAL CO i 1: CTIONAM.) 3""iM CITECK LEKT, PREPAID PWO RECEIPT DATE/� „' ` t, I By, _ I DATE FINALED I INSPECTOR $25.00 $0.00 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR i BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: N O 14' Approved by: ReS._ O Planning Commission community ity Council ........._. �Dev. Dept Initials ..._._.,. ..._._.... Case No. ..... Exhibit ' O With Conditions_._.,_._. 60, TY OF LA DING--& SAF APR FOR CONS R 1 &TE t I' obi 2$ V o D W Db �v �v CMCJ I NTA 1284 SF a C>n v (n-0_ "Ln r2 M z c) -- ©.BPT.__n 0 o O p .+ . &TE t I' obi 2$ V o D W Db �v �v CMCJ I NTA 1284 SF a C>n v (n-0_ "Ln r2 M z c) &TE t I' obi 2$ V o D W Db �v �v CMCJ I NTA 1284 SF -- ©.BPT.__n 1260 SF V� r0 1380 SF MMI 1 380 SF W y P ` r to Z 0 to o 400.5 —D v0 ------- D n C w 2700 SF ` _ = Z r+'r0C(I 1 600 SF 1 600 SF .� -------- o 0 . r M 0 r D 1600 SF .{ Z 1 600 SF .{ —A 0 ju (n 80, Z C 0 —I T'A � D i vulwof jv0 viuzn`vir ,cajua,q vjuzna v -)r ua �b auo 2�!inso7DN2 Hsa�!LL goOl Q7 -'ON 1♦1 3N`d7 t� r� °1 I 83.LVID �b13W 110 'N1VL� hM X149 V3Wv 9Ni17.1O321 .: rlsdal f (3CIM 9NleanA Jm.9 3.l3Z1hf91N 7N0� •` � L _ - • � • � Tr CITY QF� LAi QU BUI ' ' G AND SAFETY D] GARDEN WALL STS 6' C.M.U. fm� 1350psi, Fy= 40000psi #4'024 ' Vert OCL %4 0.32' Moriz 1 i 'a ALTERNATE 3 CLEAR; BENDS. y4 HORIZ.- AS SHOWN 6 6' C.M.U. fm. 1350psi. 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