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0101-243 (RPL)LICENSED CONTRACTOR DECLARATION ll hereby affirm under penalty of perjury that I am' licensed under provisions of C�hapter-q (commencing with Section 7000) of Division 3 of the Business and; ;�: "00essi6nals Code, and my License is in full force and effect. License # a Lic. Class Exp. Date ca 6349-81 � 01/3 1l2z Date ' Signature of Contractor 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).- ( ) 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. �(�A0o)° I have and will maintain workers' compensation insurance, as required by Skltion 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: Cartier Policy No. 9TATE 1,"UN0 1"29"-W (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 Code, I shall forthwith comply with those provisions. a Date. Applicant 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 di IT whose request and for whose benefit work is performed under or pursuant t6 any permit issued as a result of this applicaton agrees to, & Shall?, ihdemnify & 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 con truction, and hereby authorize representatives of this City to enter upon theabove-mentioned property for inspection purposes. Iiggnature (Owner/Agent) Date BUILDING PERMIT PERMIT#' , DATE : VALUATION LOT TRACT JOB SITE APN ADDRESS w 51,415 AV.&MMA IZAAM' XZ OWNER CONTRACTOR/DESIGNER/EN (NEER - C;OkIC NEM : ME"TMES CORON.EL C:OIdSMUCIION P101 110 3fr'? 78-15 0 C:AIY• 1`AW)WO B'lIM10230 LA+4ii7]i rA►. CA 9225:3 YAQMN"1`& CA 92253 (760)564-4604 C3 ,14 2261 USE OF PERMIT POOL ANINOR 'fP'A SPA 67X`ILY ASS Pt -R .APPROV'ED PLA14S POOL,AT4TVOl? SPA 61009.00 La WIMAMD COST OF C:ONFINUC;I` OW �r90��ti�3 MMIT FIX €1't3 W, URY PLAN ,:-HF;t K FEE 101-000,439-318 E43,63 COWITMIUC,1111014 TTF1 101-000-418-000 $81.00 MECHANICAL HArailay.f\L DI FE -- POOL 101.000.421-000 324.00 EUX,CT1.1CAL FEE -- P L 10.1-000-420-000 $451.00 , 4'1�'J3�9BE40 T'.(1l= ... P ! 01.000.419 000 3 JAN 2 3 01 Y lJ � .WUTI A� CON MUW.rl09 Ak+ D PI AN rIMM IMS M- f+1?.l 3 s>7.©t� TOTAI a FF". R FKUS DON 14Off% RECEIPT DATEJ BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs I Underground Ducts Forms & Footings f Ducts Slab Grade j Return Air Steel f Combustion Air Roof Deck Exhaust Fans O. K. to' Wrap ] F.A.U. Framing Compressor Insulation l Vents Fireplace P.L. ] Grills Fireplace T.O. i Fans &Controls Party Wall Insulation } Condensate Lines Party Wali Firewall 1 Exterior Lath j Drywall - Int. Lath } f I Final Final I POOLS - SPAS BLOCKWAL.L APPROVALS Set Backs steel Electric Bond _ Footings j Main Drain Bond Beam j Approval to Cover i,. } . j Equipment Location Underground Electric I Underground Plhg. Test Nr ;Final i Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines i 1 Heater Final Water Piping ] I Plumbing Final E Plumbing Top Out I i Equipment Enclosure Shower Pans } I O.K. for Finish Plaster I Sewer Lateral i I Pool Cover Sewer Connection j I Encapsulation p( Gas Piping j kzi I Gas Test ! Appliances I Final �L` ld/ 1111 ll I N117I COMMENTS: Final I Utility Notice (Gas) i ELECTRICAL APPROVALS ' Temp. Power Pole j Underground Conduit Rough Wiring Low Voltage Wiring 1 i� Fixtures ] Main Service j Sub Panels E_ Exterior Receptacles j G.F.I. j Smoke Detectors Temp. Use of Power I 1 Final Utility Notice (Perm)