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0205-117 (RR)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~ .. 9' CP,_�'Signature of Contractor ;Qzl,j 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, Busin%s & 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 I Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under ftenalty 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 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 Code, I shall forthwith comply with those provisions. 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. s 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. `+Signature (Owner/Agent) f ��'^%�-"- "--� r - � 4ate 2 Li ,4.. BUILDING PERMIT PERMIT# �[�•7Yo�.��i DATE VALUATION LOT TRACT JOB SITE'7 APN aty� ADDRESS W-120 AVIS .VDA R,/MM, OWNER CONTRACTOR / DESIGNER / EN (NEER UMICiE.RTO MARO NVEST 53.4 �V�i ?,4 1: k.,S +x. 70 PAPAYA LNG LAQUMTA CA 02.253 CA: ,t ', f•DM CM CA {92214 la USE OF r'EnMIT ORNFAAMPUILDINO R,'9-CXXW - TORC` I.3(7OWN CLASS A MtL°fl: PJ;kX S AVM M= MMM US11MAT&D WSW OF MMURUOrION _�+�,ilbgib9't9 y5{{yyf;���ppQQ:,))�''��qq��`y�77����jj��Et1 R\.II.�Sw:AlL♦'R'.�R�.><+'Wb. fDVRd-4A1 QY'6.fG.TlI tluG3'.Lnl� • y'q - i �a S TOTAL N�I -AND t �ZiCK.S IYAR' PRE- AY0 VE $0.00 ._ .. __...;..... _—'-7 ` . L,f'i'A'IR1,WA!MS 3"PU ft NOW 00.1m MAY 0 9 2002't W �ECE T BY DA FINALED INSPECTOR FIN � 6- cJ 2— 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 to y 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 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: .. _!`.; I_• '�E'J�� ��•!: >al� ..'nl1JE•QN.1�ii1 .. P+l�t:`i' �I tVJr+h' I I�i�'._it �_.�r' aC 04/29/2002 06,43 %60328813'i0001;11113 TROY 0 SANDLPS PACE 01 ROOF WEST 69-115 mate Road, 1WM F516 Cutbedmi Com, CA 922,u Troy B 9andm, Owner Te)mbow: (76e0) 328.4392 Lsat w No, 716359 Ft�sittlilo; (760) 328••8137 . JEet RMF 'D 66r, bereiutler tvUed the 'Coo trmcter", Prvpatrad to hrrrfuh 00 m8ttrl�l anti 18wr ueeeaeery t+n wan, comstrm:t a" plate tine fapm wwstr dcaerlbed bevvfa oa4m bwlld N6 lowtod at: 53-120 Avmrida Mmwi4 Lai Qtdutm, CA Mr. OnbcM 1•Yu►a I Mr.'e.:Mrs, Alwurado 53-120 Avenida RAnw1z La Quintm, CA 91253 wuck 6o Ma brhcmW! I. Teas otfesiAing rooiey+8tema mrd haul uwety. 2. Repair my www damaged theetfny er Ver om►2faot. 3. Sptuy On Liq,id rite aleleid at 2.5 gal P- 84- 4. i4all down (1) 9bergfeae ply sham 5. Install now OeAitog i md)-kB (unpainted) 6. Torch dowry (i) G.0. S. A- bit tnaittled to mamtbatte wN ' ' spexlAaaftana. J�LtlPrde16F r • . 25% Dcpaak Required to ftie ftRf + f M-00 25% poq:tircd sfiff 1waltatiom of am, sheet / Fleshing, S 555.00 25% Ror♦40ed m 50'X. Of Rao(traroplotion S M-00 � I S% Required at DIA of ROOMtrernpletian L 333.00 10% RMubred at Co-opkUM of ineojeet S 222 610 TOGO Eedn aft $ $•Z2tl-� i� Any wpbm4een %OFk QP+repairs be nd tkare awrpfowad "bunt, awrkoriaed.by wrar whether• a• nor $Wh 40VAMttaM fS writteri *Saari* to ky Owwr Jar ad&ttowt r o)* or alwv.,, Shull be eJ WSW need bthted scpwmvly bared on o rate of $45.00 prr htm!vr tabu; fn oda"On to dye cwr/ar swertols. 8itf: Gimitad warmly Bot a period of five (5) Yon *M date of oompietlon, epim faulty wOAm mwehtp. and tuaterials, and wn defined Dalow (Set telitn titled! Wit). 111is A© HENT shall bt+emne biftding only Upw tht COntrtilCW" wrltlaa eomrWA ere bweaf or upon tierC,oittrasto a eomrnentina perfarMWVM mud %"wont es treow m oataenerocntant of pat�►rtta this 0411 atmStatato et: Vntere aary"a mrd be biodwg upon th0 Imrti45 hOW0, OMO beim ao aowtenn+II. prurc naw of a®ra>or►®ntc, wrlttcxs err mal ether then ao covin 3st &xth. 0 1% ixiber undwOood that: • i