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9804-168 (SFD)U) I— (V U) W O � M d u7 ' W oZti co0o JV� WW I— a U) Z M LO N ON U rn a- Q 'ItZ ra0 0 J J mUU O MH 'T Z_ ob 5 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 n2�d I� ,�% } 12i ♦iiia /ate, t/ / Y Signature of Contracto6, ` YY"I y 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 Se tion 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. ST'ri'i.1 FIAND 626355,r, (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 sub��ect to the workers' compensation provisions of Section 3700 of the Labor CA, I sJ, II fort, hwith comply with tho a provisions! ate:c' Z r-1 Z Applicant I .' r� ! // A / 1. ` . y Y r Warning: F ilure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil lyl,nres 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. t 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 employeestt 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 certifythat I have read this application and state that the above information is correc�f I agree to comply with all City, and State laws relating to the building coni� ruction, and hereby authorize representatives of this City to enter upon thefabove-mentioned property fgI. inspection purposes. 1 gnature (Owner/Agent) ,w /`� %�.�'1""- Data Lia 4,.62 BUILDING PERMIT PERMITt CONTROL# DATE VALUATION 5119.253- LOT 26 TRACT 1.71702 Gs7 JOB SITE!v ADDRESS 78-643 r OMO COM APN �ifl%.•V��.i-'�1�3 OWNER CONTRACTOR / DESIGNER / ENGINEER YR11. s..Cx.GROUP RSS0117 "+K-615 NAPLES U.Ft 78615 NAPLES .DRIVE LA QUIP 1'A CA 92251 L.A! UINTA CA, 92251 (7601772-4222". CIAL.14 1959 USE OF PERMIT Sf-D x-13 LOT 26, 1RLAN 3A. P1.fLWT !'JI~ 4S NOT 11•iC'LtiDE BL0eK vFftAj..1.`.i 0k POOL. PLAN C€•1 A:K Fa,-iO)UM.) BV 75"o FOR MULTIPLE ISSUAWIK OF SAh4ls PLAN TYPE. 'I kA T.' C 014STR1 C'i`ivNI 2,02:5.00 SF POAC52.00 SFr C: iAR&6E1CAH1,k)RT 439AK, 5 Esq L UMAT ED Cl).Vf OF Ct,;eS'.. RUIC` ON 119,11M.50 ;ki1aRCF'"T VEL SUMMA Y C0'1N-fTRU4..11t.)N I"Ef-I 101.000-41 L 4") asj.�>Nf Ttc:i:; Hirt? a(iF-P){i!) =13�-3lSt fil4151.98 WX31,tV1fCAL 1"T.L l©1-(jQfl •121 $5150 fiLIA"r2ICAL €'i_:E S1"`.3.iti 110.11VIBINO FE13 S140,75 rr�aN',. ;R _ R.Ps") t01.0(V-?.t 1-!)00 5 193 CitrS1)1x 1f� i, S:fi''' 101-000-42--0010 1AiFipr�;1'lltUe."Ptlkl: FEF. 22,x-li(}O-tlF�x-i Q2 !Klt�ii.rrt ART 1N T UBL tC fli. i 'isS fa, 311.701-000-251"00 V& 13 t, �1,926.i9 LESS 1'kLETAID FE1iS W(?.!)() Mp,Y p 41998 'f1"0 L t'F,R M IT F FWS 1)1JK N'0%Y $3.926.59 Or RECEIPT DATE BY ` DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings wo r LWDucts Slab Grade 6 —Z —Q Return Air Steel Combustion Air Roof Deck-?% _ _ Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation ®t L = Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath - Drywall - Int. Lath y, 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 ,5- -CIO -q 2 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 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 L - L Final Utility Notice (Perm)