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0006-393 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that lam licensed underprovisions of .Chapter 91(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 518742 C•53 10,131/2C Date ' >r/ 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: ( ) 1, 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 perform?nce `of th�W,ork for which iris permit is issued. My workers' compensation insurance carrier & policy no.'are:e Carrier STATE FUND Policy No. 1034804-99' (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 thlise provisions. Vate:' %' /� A Applicant ��/e.r; ...� r. r I If, ” Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. ignature (Owner/Agent)f i / ✓` Z",d " 1k..z. Date r 4, - . BUILDING PERMIT PERM'�,g DATE - VALUATION eLOTTRACT �6 JOB SITE ADDRESS 7S -W.0 P10 , CQ APN - OWNER CONTRACTOR / DESIGNER / ENGINEER :8.940 LUO•E.ECO 7 3 960 11-11CR1WAY 111 LAQi7IMA CA 9L?53 PAT.m D&I MT CA. 9225$-15 (760)340-2385 CHL4 110, USE OF PERMIT POOL 1AlifDIOR EPA POOL. & SYA GNILY•ALARAA3,'13.ARMERS SHALL OR IN PLA.C'E AT PRY, PLAS T RR INPECUO'M POOL EQUIP-MERT CiNCLOWRE 18 NOT INCLUPED IN THIS PERMIT VAL.UATI(M AMA LS C. ESUMATED COST Or, C+i3MURT7MCJN 23,000.00 PEI?Wf VIM SUMMARY MAN C!-IECK TELA 101.0001.433.318 $152.10 CONSTRUCTION FLOZ 101-000-415.-000 S2134.00 MS MIANICAL FEE -- PMOL 101.000-421.000 $24.0 I;I.ECTRIC'Al;. ME -- POOL 101-000-420-000 $43.00 PLI1t DING FRE -- POOL_., 101.000.419.000 327.00 ;..r W.13-T(AAL CONSTRLTC`A 10N fiKD P',C,AI,i' CI MC.K 7T ��� t� P�7I/A:.t1-� ((����q .i[ii6�i � 1��Ii.�.Csr`e3.;I ��J..N7 l l RECEIPT DATE BY 4 DATE FINALED INS ECTOR / 1 l �= INSPECTION RECORD OPERATION I DATE I INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings Slab Grade Steel Roof Deck OX to Wrap Framing Insulation Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wall Firewall Exterior Lath DMvall - Int. Lath Final BLOCKWALL APPROVALS Set Backs Footings Bond Beam OPERATION I DATE I INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Fans & Controls Condensate Lines Final Gas Piping PLUMBING APPROVALS POOLS - SPAS Steel . - G Electric Bond Plumbing Final Main Drain Equipment Enclosure Approval to Cover O.K. for Finish Plaster Equipment Location Pool Cover Underground Electric Encapsulation ' Underaround Plba. Test It . Final I I 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 Final COMMENTS: Final S t 7- -7 r�0 Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors TemD. Use of Power Final Utility Notice v 24O 4�Cor4yrA 33aoo n t5, 1. I04-;bx- . S�s��n �'ofl . • I[r e . i�0"Tow 0 L Q�,: µata Ca j a s' t it I fA 0-D I 1 f• Sccrf+ Z TN,;+A11 2 •' e v. PoNss AIve V41 CoN+roL--� floW-, i A R6Sk&l N EE OF $30 WILL BE CHARGED IF THE APPROVED -- PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. .NO EXCEPTIONS! r w ; CITY OF LA OUiNTA ��- — -- -- - -- -- BUILDING & SAFETY DEPT., APPROVED l I FOR CONSTRUCTION - - ` ---- ! \� ;!1 ATE J G 6 BY r d e r l An C/�LTc� - �. ► i•= — i , c- NOTES V �64 Y SPt� RF sed ►`��� rh!ON k Rock sP;liv��`� isrrul ����' Nd SCf pe- t 6EJ�)o Ne AREA MAP KEY MAP NO. R'1RiN � It cove✓or �Aiucha, ► U1Rsti ► �o�� l.�Q u ► LI.C. * 5 7 l o' LOT BLOCK SEG,_ — — — PROPERTY LtdUO UTILITY POLE JQ .JUNCTION BOX ® HOSE 8I8 SKMMER DECKiXM �, � � �y -- -- -- TELE— UTILITY EASEMENT O ELEC. PANEL OB SLOWER -- FILL LINE �� LIGHT � AREA DRAIN `'AACIDIC FENCE (HEIGHT, TYPE) G GAS METER VOTER LEVELER F FUER —+ DR RETURN =_= PVC DRAIN AN —E—E— UNDERGROUND ELEC. O BENCH MARK 0 REMOTE 1ALVE HO HEATER —+ THERAPY � GRAB RAILS C CONSTRIICT�ON . —G—G— UNDERGROUND GAS = P. 0: BOX 11996 —�-- OVERHEAD ELEC. ® WATER DEPTH ® GATE 1A4LVE OD MAIN DRAIN — AERATOR LADDER I PALM DESERT CA. OVERHEAD TELE. RAM : SWITCH © P TRAP O PUMP ® GAS GRILL (760) 322= 656�'�6 ® ELEC. PEDESTAL ACCESS C� 0 RECEPTACLE --3 STUB b CUP ANCHORQ SEE NOTES rcuno nn eurc •�rm..