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9706-055 (SFD)1 1 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 6740`71 13 � it+JA )7 Date i ` I Signature of Contractor OWNEWBUILDER DECLARATION Ihereby 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.exerript under Section B&P.C. for this reason Duette Signature of Owner .y 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, selMnsure 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 Son 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: Cartier Policy No. STATE FU NI) i:'+i Ityv_,,YG (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 bjecf to the workers' compensation provisions of Section 3700 of the Labor ode, I_ hall fo. hwith comply with those pr©viss: Date: (1 Applicant' i 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, & shalli 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 cancellatio 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 t e above-mentioned property for inspection` purposes. gnature (Owner/Agent) ` ` Dated - BUILDING PERMIT PERMIT+M - CDNTR°`# 97II6-055 5 312 DATE6? :5/97 VALUATION K173,2Z5.00 LOT 80 TRACT ADDRESS 78-870 CASA DE, 1, ]RIO JOB SITE �N Q>+a�w•332 OWNER CONTRACTOR/ DESIGNER / ENGINEER '11:3 DC,,',S1 R'f DEV 111 Ji PA SI>.h.MN CON51'RUC=: JON PO 90X 710 7929 RANCHO LA QUIN T A D1t, LA (.-;UI.N'I'A CA ')2'2 GA C 1J[NTA (,A 022.53 (70)771-15141 C13L4` ZN6) USE OF PERMIT SPD SPL) LOT WHIM fd 1+'.f .31311 a USa 1'01b1 CLL, :;r9.UC'TION 1380.1.9. i :Attr�t;d'Ji:Actl'�Jit'f' 7_tN-110 SF` . II.%TJ1%11' C, D 4CO3T a:;V t.'0 NXFRLfl:`>1•10N .11731,225.0 !'C�>E MIT 1N`CC SV84IVIAIcV C0N8'l'R0:71'l(71N FEE 101-U1)l?-119-000 Sr► r'r.•!IN rttr,, frrr? 101-IN(JI-439-318 ST?3.45 11[•;4'3'1A;v1it:-AL FEE 101 -WO --4.21.,000 HLI C-' 10C'AL 14JI .. 1.0140)4,20-006 $111.19 f'►.tr119H.)tic'.1 %?G 1111 -OW -419-000 X1.36 (tri �Y� r :rar3 Puf C)1`i/JN t)'_c• . fJntl� I (11 -00 0-141 1`1I{.rtLr(; dt� 1 I L 10 f _000_42.'1_000 i-060-14.3-342 t, 97.56 ART Its i'(r14lA(I 11I.&''1•S - RR.811 01••(0)-2,1%5-0(X) 5l$3,06 I -n AN C'IfFY ITY, 71 1.01 -of t t4 58 S F (Jl3aiOl`:11 t_47N.''[!t)Jt I7r11a1 _AN17 P1,01 0 IECK$r063.08 I. ti> I'ftl:-1>sa111 f f 17„ $542 8 TOTAL N'EMUT IFFXS 1)Q19i 'NOW ss, 514.4i1 RECEIPT DATE B DATE FINALE 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 91,77 F.A.U. Framing Compressor Insulation f Vents Fireplace P.L. Grails 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 Pibg. 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 COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) - ,Z-