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0007-247 (RPL)U H N U) W O co LL7 LU C) z � OO CD LLJ LU J U r` -z M L0 (\J ON U0) Z `rlaCr 0 LL 0 J J m U U O rn Z_ O 5 �a J LICENSED CONTRACTOR DECLARATION _ I.`4areby a;fHm 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 License # Lic. Class---. � Exp: Date 69©6,45 EIW ' ,A _ ,-tee f /06/3012( ate Signature of Contractor W 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 r1M COMPANY OFT Policy No. . WD191'' D41900 (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' nd agree that.411 should become subject to the workers' compensation.,provisions of Sect oct.,3700 of the Labor / �l�de,fl shall forthwith comply with thgse'provisions.,,�', .....r...... ---*�-- VDate: v `` `' Applicant— Warning: pplicant 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 con truction, and herebyauthoriz�/represeritatives of this City to enter upon /thabove-mentioned,pk`operty for'iRspection,-pu'rposes. • . ,,�ac� Signature (Owner' /Agent) ✓ r° Date BUILDING PERMIT PERMIT#W7-247 DATE VALUATION LOT TRACT S UAWAXII JOB SITE ADDRESS N)_SW I'OIN APN ^ 'OWNER— CONTRACTOR / DESIGNER / EN (NEER RJT INV1+;8"I'MWM, INC. RJT WVF-.Yi2Vii?ms, INC, 14 251;. 'LT_RMR.T'1('DFJV)_'1 1425 F. UN.IV'FRMYDRI' ? PHOli= AG 85034. PROEUM AZ 85034 (602)257.1656 CBJJ t 4990 USE OF PERMIT POOL.AM /OR MA POOL &SPA. ONLY- 1..AIZMbY18R,"r 1ERS SH.A.L , BE 1N PLACLAT PR&PI ASTER Ilei—TION VALUATION 106000.00 L3 COM O Y COMMUC-110N 10,0W.00 Ay�Ew'{A�ilil"1.L'D A ZLY.LILYI�J.1.PJib �i V.�Y2.iG-064� E PLAN CHECK M 101-000-439-3] 8 $76.05 C6%13't'RucTIO24 1e8 101.000.418-000 $1I7.00 MECt1AN1C.AL F -- POOL 101-0004ZI.000 SX00 EL.16 TR1C,AL FEE — POOL 103'-x100. 120-000 $45.00, . ---"P1.UMB11140 FU-- POOL10?-DTIO,419.000 ! =7boI AUG -10 2000 *JTY U 11 SUB -3.'OTAL'CONORMCn0lf AM PLAN CMDC $289.05 um Frm.-PAIDF $0,00 TOTAL d .R.LrLiYY FXE8 ME -NOW SM.05 RECEIPT DATE BYfr DATEFINALED INSPECTOR INSPECTION RECORD r 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 POOLS - SPAS Steep 3 �1 Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test 17 1 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 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: fe/o $� (� C L_ (� G nJ CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DAT /)0 JBY 6AL/ A E -INC A GEO F WECT10% FE' Wit BE P NS ►tE Ott ID 10B AAD S S TH IN PECTIN. NO EMEPP01