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0211-214 (SOTB)LICENSED CONTRACTOR DECI_t A ^ 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 ?i33303 ;131 C10 me 08/311,x( Date Signature of Contractors [,- 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. ( ) 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 EXEMPT 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: r� 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 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)'' - 4" Date- /7-� �i • „✓aL, BUILDING`PERMIT PERM"' .. 11',`t #,-�14 DATE / j' : VALUATION Uxow LOT * �` TRACT 29147-1 JOB SITE ADDRESS .F"17+63:5 �ai ID�a , t, z. OWNER CONTRACTOR/DESIGNER/EN (NEER WM=0P ' PARTNERS LMC : It;AFTUT LA GONMi,+Ca At,..)J j, --it 55.161 ISOUT .`lt[{kMUILS 78-070CADIZ . LA QUJNTA CA 92253 1A egiamp. CA. 92233 (760)5(54.483.1 CRW 32-37 USE OF PERMIT s ! '• i?'')kV0 I11Z291,AV.Z PER APP1l:C1VFA) PY.ANS VAILUATIOW 26009.00 LB COS" OF CONmT:tCT10H 2,!11.°0.00 •meq, y���,� jT @ryyf a �RS"Tll�'AIVO .i'yl3�~Jt.Y���-;�.lryl{�]�i��i/ if�E�jPlp�Tf.Y.rAR 101-000439-338 �y (��j gry(� q @ ¢ P�L}.0 N_(11S1'FICKYS�•S'a7:ti��y+1y01"`«tW/V�"`/?��{lA°/.7�3�p8�, . µ9�✓ls!� C''014N'i'k'dYt;".1'101 F,72 10&"'I100-'FD•S�f"000 MOW MOT1010 IRM - REMID 101-000-241-000 $150 SIJJ?,TOIX C01T$—TR l6 Ca b' AND ;SLA—I.3' CIMM LS30 11RU-11AW.M,S $0,00 1�.Rd'!,C' � r�.:.�...d �i�]C:�.J.°-`L7 �C/.4:.' A71P 7C D •per( NOW $7 y 1A 7�e I5 DEQ OF LA s CI DEPT. NANC.E IUIN F RE'CFIPT DATEy / BY DAT I ALED INS;eT 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 J Exhaust Fans O.K. to Wrap F.A.U. Framing a Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 72.6 Drywall - Int. Lath Final Final� � POOLS - SPAS BLOCKWALL APPROVALS 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 Encapsulation Gas Piping Gas Test Appliances Final tUnderground COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS i'emp. Power Pole Conduit Rough Wiring Low Vcaltage Wiring Fbdure�; Main Service Sub Paneitq Exterior RI -7 c-eptacles G.F.I. ` Smoke Detectors Temp. Use of Pcriver Final Utility Notice (Perm), 6)04 . LU. O � M I LU t� a Z r� �0. CO Waw Z ch N O0) UQ 0_ — Z Cr T Q O X W LIL mUU O Il rn H qc31 Z_ co 5 � O " Q J 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 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. ( ) 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 irmn 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. 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. I Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE VALUATION LOT CCT 0p $2„t3� %00 48 JOB SITE ADDRESS �9'7-&�:` BT.,AC , DnJk APN - --- OWNER CONTRACTOR/DESIGNER/EN INFER %SIC OPF P AMWF,RS I"T ' YIPJIUHIIAL CONZI`??" 0.°t0W We 55.1.roI SOVEXIE. NPIM O WOO CA IZi. ... LA CSC INTA. CA 9223 I...A QT 5,gTA, CA 92253 V60)S64• 483,2 C.Bub 3237 USE OF PERMIT PATIO Fii(E33LA.CIb' PER . PPROVFM PT AWS `V•ALUKHON LZ ESIT tiAIWD COST OF C0.I48TR1JC:T.'LON S:`.Ct'R M'Ftea:411U. hl-A:RY PIM C IRECK FFIE 101-()00.439«318 $29125 CONSTRUCTI"OIN FPZ 101-000.418-000 S.a0 STRONG MOTION M- REBID 101-000-241-000 L0 MM TOTAL CONMI UCTION' ARS) :PLAW MIRCK S74.15 RECEIPT DATE BY • ,'ti, .DATE F.INALED INSPECTOR 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 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 POOLS - SPAS BLOCKWALL APPROVALS 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 Gas Piping Gas Test - Encapsulation Appliances Final COMMENTS: / 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)