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9704-022 (SFD)H N rn W p co LoW w Z 0� T 1 P oH W CD Z M LO N 0 N 0 °' CLa r Q 0 0 J J m< O �0H ,�d- Z r-0 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 7 41 ' 13 itir3ii97 Date Signature of Contto' rf� OWNER-BUILD/EA DEDECCUARA• °ION I hereby affirm under penalty of perjury thai >ame'' pt 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. 7644, 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&RC. 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 Policy No. ZENITH INS, CO. (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 3.7.00 6 -the Labor Code, I shall forthwith comply with those provisions'- Date:�, Applicant— Warning: pplicant Warning: Failure to secure4Workers' Compe�satioR-coverage Is unlawful and shall subject an employer to criminal penal'es a 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 andattorney'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) - +" Date`'" ' PERMIT # 22 CONTROL ROL## BUILDING PERMIT 470" DATE 417197 VALUATION S —474.10 LOT 9 ; TRACT 2530 4 1 JOB SITE ADDRESS GE�SS 4S,32013RIDM WAY APN 604,U2401 01 OWNER CONTRACTOR DESIGNER [�A ( (�y {� {��y ` p {(�{{�� CPr{vri f�JP.I Ci QWIELt �.aCC)MI., iSiF Ptl ,S � y/�ENGINEER y/ y �y�{ r � �~4�t�i�k P01ir L.KOI.Ar"l L1;1."..-�l�ilINI t 91 ri 11 r3, 15-15 S 11011 1`r1. 1.335 SO. T" S-1REff 5"C'& N100 SAN .Ltlz12'11f A1°i131_-117 t;,'A 92403 , SNN :O i MAR DINO CA 92408 (900).381-6007 C BL# 2120 USE OF PERMIT AVID-.Pi:fWIT "L'0a NO i:tdCLUDl BLOCK WALLS OR KXX. KiL-1 RKY, l i AN 3.0-& .PLAN t;:'f iUCK F11133 KEIDt,lr' M BY 15%) FOR f16ULT1PLI3 MR%Of SAfM LAN'f YPP. "IRAN!' COWSTRU .i'lGN' l,ir';3.U© S;+ (;ATCt1.(JU- C"KRFURT 417.06 51r` ss to ` a) a ©I�� f�; tx:r�c� tt�1� ",474.10 y tf a,`WVfl,�T i+'iJ.�%'�i4�(Q`Ii19ARY PLAN (71.—MCK F.f%f C.0N13Titt7Ci'l.Ot ME- 10!-Cion-4,I,8-ifM ${a 1Sf3ti irc�i Ar1I� A , rL x01..000 -421 -OHO S53.50 L,'L7€,"i'`R1CAL°l,rX. :101-00-420-00 P f,(PrlLiff it,s FR 1_d)1 iitlti-dlU-4K 7 $148.00 :NON1(D't"t0PffLTM-RES!D 101-000:'-241-000 (ARA ING ME 101-000-42:3-0d,1M � ti.iftl W141 A 131fRUCTOkVFU22 -000-443-3 42 r TkL CONFMUCTI ION. _ND MAN- CHECK LESS BU -1''r ID PEES `0 $1997 T(Yf M, PKRN1Vf 10, WS UEN1OW �pR y3,:33(i.;B16 Gr t REC. DATE By. `�$' D E gJAL INSPECTOR a r d)'EIPT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings t tKA Ducts Slab Grade /4,,v Return Air Steel Gas Test Electric Final Combustion Air Roof Deck Water Piping Exhaust Fans O.K to Wrap /S F.A.U. Framing S' Compressor Insulation,e—n 8 Vents Fireplace P.L. Gas Test Grills Fireplace T.O. Fans & Controls Party Wall Insulation Final Utility Notice (Gas) Condensate Lines Party Wall Firewall Exterior Lath S nnAmau _ int i art, r o� 0c, 04 Final FinalPOOLS BLOCKWALL APPROVA S - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste LinesHeater 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) COMMENTS: ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring ' Fudures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Prover Final / Utility Notice (Perm)