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0006-367 (PLBG)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chr�ter 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 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 of exemp>under Section B&P•fC ,for this ; reason �--- Date Ea �� ����!C3t:! Signature of Owner i� �' �- ec_ �;t-1.. _X__ 11 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 Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). yC)` I certify that in the performance df 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 wit those provisions.�/ Date:'% �.CC Applicant 9 Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent)/7, '4� ��°' -•• •Dated: - °�✓'-*4 + s BUILDING PERMIT PERMIT# DAT/ 000&367DATE , 60 ' VALUATION &tS00 4D0 LOT TRACTJOB SITE i ADDRESS AVi.:l�tf. A RAMIREZ APN 4 ` OWNER CONTRACTOR/DESIGNER/ENGINEER 5345 5 AVINID A IZAI>UZ 53455 AVERMA RAMI R LkQ01NTfig CA 92253 !A QUWTA CA 92253 CBz,4 USE OF PERMIT P UMBINCY SEPTIC VALUATIO14 11,500.00 LS 9SUMTE» COST Oi' ('i)d1T,5'MMON tJ 5UUA0 l)kaEM!".i'FET UCIMMARV PirilA>YI3 O Int E 101.000•-41$-000 130,00 -wS ALa SUB -TOTAL CONST:Ill:iMTON AND PTAH ME CK $30.00 :L 'M PALE-PALD MES $0.00 RECEIPT I DATE I BY � V\( IX \ I DATE FINALED I INSPECTOR INSPECTION RECORD ' ti 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 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 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 Q Gas Piping Encapsulation 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: 14:32 d2 PD WP PAGE 61 65i?6/20©0 . I COAQMWlll J► VALLLY Y19►'18101gTRIOT l CASH As iI� tAIL c te:.�ZyQ° rael Idreae: Ytaot_. sCount No. i t(a) - a.A.OQ� . • rnlce nddre0e ��- � . t Motor(%)' servtoo(e? - - , • I HasmLatel -� I petecto�Cneck(el ,�•� � I meter ¢urcha(GeJ.- V"9arlltallen Ga ly Cnatpe, W.$.B.F.C. Twnporerll Co6trucllon Meth Tum on CnaroF 7 t,�ncollecled At mnt - Name 7 Inepectlao Fat - Tradt - . i Fee - 3 Marl Ch$Ck F$ov Water ! Sewer - Tract - — O sono Payrfil - A.P. - Aeemt '� CuettNner Depcalt ' rJ Otnet TOTAL 6 rtatnerka: \ ' A , to* Wato UNI" Chock money G.11V1 Iib lttlBiD Order ...... ...............���/