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0005-228 (ELEC)-- LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury th�t 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 233809 C-45 2C Date �r ZZ -7 Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury ihat I am exempt from the Contractor's License Law for the following reason: ( ) 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). ( ) 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. (,el'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 9TATg FVJ4r) Policy No. 1020$02-00 (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 rov' sons of Section 3700-of'the Labor C p '6 Code, I shallyforthwith comply with th _ se pro Isj ns/ Date: 6. Z Applicant Warning: Failure to secure WorkehsxCompensation coverage is unlawful and shall subject an employer to crimiria'l 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. i. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is perf(;rmed 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. Signature (Owner/Ag ntifn A/W r, bate,—V.7 BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT 0.5/1 7a(X ZtSIMM -P-AY- .3 2852-S�,l JOB SITE ADDRESS 7.4_225wcanwAyin APN 64"30--031 OWNER CONTRACTOR / DESIGNER EN61NEER DAVE STAPX CHWY KIGN W�. M .93191 HIGHWAY I I 1 85-850 AVEMESS INDIO CA 92201 TM10"L CA 92274 (760)IM-6313, CBlh 774 USE OF PERMIT INTERN.ALLY ILLUMINAUD CHANNEL JETTER SION (SUSARU)PER SA2000-489 OHLY VALUAMH 3.S00.00 LS ESTJMAIrJ)COSI'OF-COI'igrllUCIION PFIWf M SUMAURY tLECTMAL FEE 103-000-420-000 VX00 f SM T01 AL COX= EMMON AND PI" CT-MCK $30.00 LESS ME- PAW RM $0.00 TOMA.L. PE RWT il-HEEN ME 110W. MOO RECEIPT DATE BY DATE FINALED INS ECTOR INSPECTION RECORD OPERATION j DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs . Underground Ducts Forms & Footings Ducts Slab Grade Return Air - Steel Combustion Air Roof Deck Exhaust Fans OX 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 POOLS - SPAS BLOCKWALL APPROVALS 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 Pool Cover Sewer Connection 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. 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