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0011-143 (RPL)N lJJ ODM d in LU 0: Z O f— (o ti LUWa CO Z LICENSED CONTRACTOR DECLARATION I hweby_affirrn 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 C53 ? Q? r"if312i Date T' Signature of Contractor 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 Policy No. 3TATE F'IR 4D t $02.00 (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 3700 of the Labor Code, I shall forthwith comply with those provisions. Date:; Applicant--. - Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to -the cost of compensation, damages as provided for in Section 3M15 of the Labor Code, interest -and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work Is performed under or pursuant to any permit Issued as a result of this applicaton agrees to, & shall, Indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any' permit Issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work.for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes: Signature (Owner/Agent) """- _. I, - Date II i -" BUILDING PERMIT PERMIT# DATE VALUATION LOT 001.1-141TRACT //!! JOB SITS ` APN ADDRESS OWNER CONTRACTOR/DESIGNER/EN INEER PO DOX.171 f 74.725 JONI MM',9A I LA QC):LVITA CA 922$ 1 iMIM TJE RT CA t -60 (760)340--9000 BRIM-fF 3:;86 USE OF PERMIT P Ky:I:..AND/O AND/OR UPA K-001, &4. SPA (2) WATER P'RAY't.iGtYLS (1) SIJJQ A14SI Z21381995 ONLY-ALAR.PAt3tBARR.119KB SHALL BE IN •PLACEAT 11I;E PLAOTM INSVPZT1011.rOOL 1k)0JPMr1HT ENCLU L➢f"E-YS VOT INCiAlID D rN THIS POOL AN DIOR BPA 14W. Do tus " COME OF (;ORIM><r(M0n 16,54:0.00 l'LA10CIi01;'tr r 10)-000.439.318 $117100 CONaTr'Ui:.TION PEE $154.00 103 RCRAI-TICAL ITEC; - i X)L, 101-000.421.0TO $.4.00 EL.1'!:t.` RISICA.L, FRE .. POOL 101-000-420-000 90.00 1?i..l1113B11�ICf FRE ••K3OU 103-000.419-000 $27,", T . LESS ;PRFr1PA1DFM4V "'00 k faTd 7�.i1'I' FEE13 XTF, Na`i'U4t' 13s93DU RECEIPT DATE BY r'"" DATE F.INALEDp INSPECTO - MSP CTM RISC ORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR 3UJLDWG APPROVALS MECHANA CALL, 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 Fera! --- -- - POOLS o SPAS Steel Seo Backs Electric Bond Footings — - Main Drain Bond Beam _ Approval to Cover i Equipment Location. _ Underground Electric _ Underground Plbg. Test Fnal Gas Piping Gas Test '��^� �;,G��G�©��' 3 — CK �� Electric Final Waste Lines �— -- -- Heater Final Water Piping Final Plumbing Top Out _Plumbing _r Equipment Enclosure Showar Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final — y COMMENTS: Final Utility Notice (Gas) . C LIECTRZAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fiutures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm)