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0207-224 (SFD)CA fV LU W O =5 co W r` tr oZ� Zo 0.0 I— cD LU IW— cL Z co to N OQCJ U D- — Z to aCc 0 XWY. m<Q O to Q d 0 Z. oo (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- 101 pplicant ' ``• -��+ ��"" Warning: Failure to secure WorkersCompensation 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 qn his application. t 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 it 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 i ' correct. I agree to comply with all City, and State laws relating to, the buildin' construction, and hereby authorize representatives of this City to enter upo the above-mentioned prope rtyfordrispection purposes. Signature (Owner/Agent) rr w.• -,i k...,��r-+ "" Date�j LICENSED CONTRACTOR DECLARATION 1.7 -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 k Lic. Class Exp. Date 'B Tita Date f Signature of Contracto, OWNER -BUILDER DECLARATION f I hereby affirm under penalty of perjury that 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). ( ) 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_ 'N�( ,)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 0-pA..-k'g`d+tl't4D ` Policy No. 1.14 *16.02 li BUILDING PERMIT PERMIT# DATE/ jj VALUATION LOT �p TRACT i JOB SITE b ADDRESS 79-353 HUMDALE ALE 00U) l' APN 170 -2.W -C 31 OWNER CONTRACTOR/DESIGNER/EN (NEER AL R01115 LLC '.7r0u T C0149 UCT.10,14 73960Hwy 111 #6 *73-191150 11. I:y.`.'�'4�:1 plX6 ' y��yA., A ry, r 1A Quwrka CA 7.20.'Ri�.`.t 9�e'a���y�Y h t IVLaEb�. .�lRE.°rWZ3IRl CA 91:266 'ds�. 6063 USE OF PERMIT ij77iWG{{lFA10+ DtlC_Q,1tG :;F 1 ZACiri VY—S't'd'dS.iA W#'00LIDRI1t'EWA''Y' APP Af;`;I°I/C0 PFQ. WITfi .4 LI, K0►I+RAL &* SY ATT 7 W% 04CLUDIXTCj'i HE F'l+ DAK1,=3FkED f(MO-r CFS AVr OV I M IF aAPPLICABL.E,13 R2Q1 LRY.D CUSTOM C'014 TAUCTIONI 4.810,00 SP PC7W-< IiIwrlo ' 965.00 3V C3AI�tA<I C? I1 C1i2"I' ` I� 3 ,iiQ SF .7,17 ,CSdi-1 �3,16:�e1 W," C -Of .'V9'.C.,,W.+7.d As:d1O 410,12 �t F�rV Wyn..h9� ,jQ ryN��j'A-.}M�,yri6rR .IF l.l A� � ptC'Y.6AXY.a�1A1 A h ' CONSTRUCTION PER 101-000.438.00(1 Si,rialoC PLAN C'HECX PEZ 101-002'-4 391 318 $1,421.46 VRL+ DF—POSIT 101.000.439.318 -11,0f1ao-00 114TW`3.F LAICAL W, 101-IDOO-471-•000 R%EC,TRICAL. FEE 101.000-420.000 $233.01 U. HU40 FEE. 141-000-41.E-000 $28;123 STRONG.VO'1'iO3_.F1f,.-1490!117 101-000.241.000 U1,04 Ot?EsrO!'R10t? L+. 101-000.423-000 $15.00 DEV9.f Pr1,R IMPACT FEE S;4405.00 ART Yt4 PUBLIC PLACES - REEK V0-000-445-000 i-000 $525.93 i i�TS91':C:44 Ct $6,880. A 9 LT105 Pj,;(Z-PATD T ,15.2 411,0tmoo 'I InyrALIPFAO.W.Va's "DVE DOW OCT 3 7002 Z 2M. 19I �. CITY OF LA GIUIEITA RNANcE DEPT. r.. RECEIPT DATE : BY/-` 1 sr' DATE FINg%QED C �Y INSPE �. �.h���"ti�d " • INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts p Forms & Footings .O Ducts Slab Grade Return Air Steel Combustion Air Roof Deck o S7 Exhaust Fans O.K. to Wrap _ - ©3 F.A.U. Framing ^ f Compressor Insulation =� d Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall -Int. Lath -71-1-7—da 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 _�•-� vJ iG P i Final 01 Utility Notice (Perm) �/� COMMENTS: