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9709-051 (RPL)N LL! r � Q E[j ' W O Z CZOOO �� J F- CL to Z (') U) N ON U °) CL Q It Z Cr LO a O X W m U U O d 2 H '• Z_ Cb5 O Q J D LICENSED CONTRACTOR DECLARATION ,I hereby affirm under penalty of perjury that I am licensed.?d provisions of 'ghapter 9 (commencing with Section 7000) of Division 3 6fthe Business and Professionals Code, and my License is in full force an ffect. License # Lic. Class Exp. Date Date { i 4 (Signature of Contractor �y l 1<` OWNER -BUILDER DEC 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 SXction 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 �y Policy No. 1 .+' ,,P b � f t% /' l f ice+ },l"1Y (This section need not be completed if the permit valuation is for $100.00 or less). () I certify that in the performance of the/w'ork for which this permit is issued, I shall not employ any person in any z_Ii_l the so as to become subject to the workers' compensation laws of Califo, and agree that if I should become subject to the p� rs' compensatid�vl o A" fJSection 3700 of the Labor ,ode, 1 X11 to.tliwit comply with the '-vV'slons. Date:/ / i} Applicant I Warning: Failure to secure Workers' Col'npensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify .& hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this appli tion and state that the above information is correct. I agree to comply with I City, and State laws relating to the building construction, and hereby au o(ize representatives of this City to enter upon fie above-mentioned grope IL f6 fo,4r I%,�'�econ purposes. �� /Signature /Owner/AnP.nf� f nate BUILDING PERMIT PERM' CONTROL# 5891 VALUATION LOT LOT TRACT � DATE_ _,42 9 A_ N V �� JOB SIfE ADDRESS 'fV'lp[] t �s�:i�t;AWN APN OWNER CONTRACTOR/DESIGNER/ENGINEER 1101lr1LD L Al: c';:' NDAC1: 4l DUNP11Y FA;R11i,.'4' I�at:tl � Ct:>Pd�1;ttJC;t'J©�: ,W270 CAMINO i.,A1r'tlblEM 5KV0 A ENIDA. iC1>>!t 11 LA Q1.IQWA CA, 4)225:1 LA QI )NTA C'A. 92253. (itEfl�.Sfil.'t�55 C:.13t.ff ��;�� USE OF PERMIT i't�lt:Jl� POOL AND if,1 0_\Ff k i'ir•:t� y tkvi 3F�,:Je"� >sisr� ZC,�{3ii,GiJ %.'.`: It IV; I itRfsi ttT F9'aC 1.7YJM41'AA PT. AN t„ WKC«K MR, t f�f-;I€)tf �i ��:3'I� !) t•4�l �I+f , (31.N *.,-TRT TCT (r^ N FIT 1(! f-t7(it)-uJ'.I R.(yN*I �r�+ �4�L•:j..°tlrRXvltsbOt. I"d.a: •-- i�C7t:`!$, iUP-'�I�t••�xd••t3�f1 $.^.•i iltl � VI.t?tuf ONC'rFhi3--V KA, 101-090-41940) $27.00 T_ Q,f W 0 C) L ia1WM11010N ANT) PLAr! l;�f.liC�. . Y- �.$� X.) 1.,'l.SKi.t1;"-S�r19 10,l'Al,10FU4" IT li+'EE P11Es NOW 2.41! .$452.40 � y1:_J RECEIPT DATE BY' DATE FINALED 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 BLOCKWALL APPROVALS Steel POOLS - SPAS 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 /3. 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: _ f'1 Equipment Walt �3 0 i 07, T—Er 32• CITY OF LA QUINT# a, BUILDING & SAFETY DEPART�AENT COND,'N,�LL.Y ACCEPTED FOR, Cir NS'i`0`RUCTI(DIN, ;i SUBJECT TO INSTALLAI-10"v AS Pct AND ALL APPLICABLE CODES s ` 22 BY s� 12# Dunphy Home Construction Fountains (619')564-3655 X658996