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0302-203 (RPL)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. + L Exp. Date, / 77$2i�0 � � , G�513112C .•Date ff� 1 ! 'Signature of Con tractqz"� ' OWNER -BUILDER DECLARATION 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). ,r ( ) 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 1I1PT 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 that if I should become subject to the workers' compensation -provisions of Section 3700..of..the Labor C,ode,d shall forthwith comply with those provisions. iDate'17, . 4 Applicant : _.-�r?�Y .01-r 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. 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'fo'tinspection purpose ✓Signature (Owner/Agen0;-!!L�"-� - Dat b BUILDINyG PERMIT PERMIT VALUATION LOT TRACT DATE��.�Mq/y a uu qy ��•yy /��ryry�� ryry��} JOB SITE ADDRESS &3-340 AVENIDA RUBIO APN OWNER CONTRACTOR / DESIGNER / EN (NEER PAT DOTt%I01< rY l '"LEGACY HOM 0 2.21424'. RSCJt3EWOOD 47-` 50 ADAM :3T.R.EYT 9-2 2 8 RANTA.ANA CA 1:.,AQUINTA CA 92253 (760)564=7820 CX31# 02063 USE OF PERMIT POOL AND/OR. SPA POOL&Pr..k ALARMS! BAI;.Ri RS SHALI, HE IN PLACE AT, RRY.-PI.AN:'ER DISPP;CTION. EQUIPMENT EMIXISU E NOT INCLUDED FOOL AND/OR 13PA 1010001W LS . . EM'4:10 A31M COSM011' COI° SITi;JC°nON It3,tA34bpCb PLA14 OHECKM, 101.000.-4,39.318 aiC05 CODS FUCINON IpC.L . 101-460438-040 W7100 . ZLEC RIC:AL rfik. -- POOL, 101.00©-420-000 $45,110 PLLIMBINO FEE - POO1, 301 ••01211419-000 $27.00 Id ECHAINIC AL FLJ ^000•423 -000 $24.00 SPR 18 2003 CITY OF LA. Q pp4TA FINANCE DEPT, SVB-TOTAL LOW U.C" i`7O$T AM PI -49 HECK $289.05 PRE -)PAM F ms $0.00 TOTAL 1:1KRWr-NQS DM ROW afaciw 1RECEIPT DATE r / i !-,,[BY DA FIN E INSP INSPECTION RECORD OPERATION 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 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 -G �— 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 OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final — Q Final Utility Notice (Gas) ELECTRICAL APPROVALS. Temp. Power Pole Un(l rground Condiit Rough Wiring Low Clottage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perms COMMENTS: _ COVE,BEVELOPMENT PLAN LENCH DESIGN GROUP. P.O. BOX 450 • IA QUINTA, CA 92253' POOL ` PHONE: (760) 5"1866 FAX: (760) 5"M7 POOL PLAN PLAN ARCHITECTURE & CONSTRUCTION 4 M •• r I . : I 4�mm gN2 iyl . • i I j�1 3 �ONf?� a } My ��/ .er000v�Z4o a I s KE . `"fro m ♦ n , n POL EQUIPMENTcl $¢ c o A'OS 3NIl 12i310b1--, ❑ O 13 COVE,BEVELOPMENT PLAN LENCH DESIGN GROUP. P.O. BOX 450 • IA QUINTA, CA 92253' POOL ` PHONE: (760) 5"1866 FAX: (760) 5"M7 POOL PLAN PLAN ARCHITECTURE & CONSTRUCTION 4 � SI � N tFi y � ro m Lo • C r v, ro z z z m � N 0b�rn�� cn ro m Lo n 8 w F7 — jo z z m .oaf v7 r � (j) of •• i N � O Z m o D iryti< s _ Ln 1N1� ry.'f Z v W Z r�n:Yt O D O X 41 C W N C Z m N 0b�rn�� o ro D V Lo 8 w F7 — � W co m z n 0 W m zo� r 1 "v • m p Lo jo z .7 m v7 r � o of A N � OV o D w m oro Z O D X 41 C W N C Z m n _-, t:;r c 14* 1 "v • of .3•y_,`-� Cin _`:$l.i.' m n _-, t:;r 14* z rF: r m . f. -: 6-0" =.f3 = rG gm4iyP �0� Y�Zm�nm ;izi'Izmo mmn OEM NpN�Q�9�=uZiy �DD �67w m0 2m C 0 COVE DEVELOPMENT • PLAN LENCH DESIGN GROUP P.O. BOX 450 IA QUINTA, CA 92253 POOL PHONE, (760) 5"18" FAB: (760) 5"M7 POOL PLAN PLAN ARCHITECTURE & CONS rRUC nON "v 'a