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0107-129 (PLBG)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. Lic. Class Exp. Date 746159 C42 Date �" %'"` 'C Signature of Contractor,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 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. (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 wltfi`those,provlSlons. Date: APPlicantf , a r ..._. Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest andtattorney'slfees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. , 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation: I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter. upon the -above-mentioned property for inspection purposes. Signature (Owner/Agen4)w fr-- — Dated BUILDING PERMIT PERMIT # DATE VALUATION LOT t(��:f_.�'d4 TRACT -� , -T t) JOB SITE APN ADDRESS 46-260 OWNER CONTRACTOR / DESIGNER / EN (NEER tti 6Mt ROADRM w240€ Ix MUM CABAZ0,141AA M10, CA 542201 LA, QTJMTA C. 2233 Pltb'(JA DFISIOU CA 92261 (?60)34&2793 C GIA 342 USE OF PERMIT MURANVV4'% VALUATION; ENMIATM C061' d'W CON.S. UC310.t3 2, 1_'W'0 i;,rum.s:i r rn ffuhwAwe 1"tLUMBEHO f�C'Ei'E ..,, e$�.�PER 10).-000-419-000 C•� w, � f l JUL 17 2001 �! I✓' CITY OF LA QUINTA FINANCE DEPT SUB - TUM, CaO'94MIRY1 OR MD PLAN (5MCM,. $30.00 L2,33 PRE -PAM 14M2 $0.00 t RECEIPT DAT.EI ! ` EYj Y` DATE FINALED 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 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 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 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 Sewer Connection ' l O Pool Cover Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Z _— 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) EC SEWER SERVICE, INC. dba ECONO SEWER SERVICES P.O. BOX 192 • PALM DESERT, CA 92261 17ani 4da_7704 171Mn1 492L779n JOB WORK ORDER 14 8.3.3 • ' , , FAX° -(760) 347-4978 DATEOF ORDEER/y TEEE SERVICE CODE PHONE - TEC NICIAN HELPER STARTING DA E TOTAL LABOR L PLEASE PAY FROM THIS INVOICE. NO STATEMENT WILL BE MAILED. TOTAL MATERIALS TYPE OF WORK DATE COMPLETED ❑ CLEAN DRAINS ❑.OTHER ADDRESS $ Jr Q �� ❑ SEPTIC TANK ❑ GREASE TRAP CITY ❑SEEPAGE PIT JO AM AND LOCATION ADDITIONAL WORK NEEDED: TANK SIZE: ' PAYMENT TERMS NET 10 DAYS FROM DATE OF SERVICE 11/2% PER MONTH CHARGE AFTER 30 DAYS. DESCRIPTION OF WORK: CONDITION OF TANK BEFORE SERVICE _ Good _ Trash & Garbage _ Excessive soap Fair _ Overflowing _ Sand _ Poor _ Blockage _ Repairs Needed Very Poor _ Odor _ Roots _ More frequent service needed - TpTAL PUMP DISPOSAL FEE TOTAL LABOR PLEASE PAY FROM THIS INVOICE. NO STATEMENT WILL BE MAILED. TOTAL MATERIALS DATE COMPLETED WORK ORDERED BY TOTAL AMOUNT $ Jr ❑ No one home ❑ Total amount due Signature A. for above work: or hereby acknowledge the satisfactory completion of the above described work. ❑ Total billing to be mailed after completion of work COACHELLA VALLEY WATER DISTRICT r CASH RECEIPT DETAIL z` wo .rvedFrom �►4 OM4rJ G ;R .adress: v Account No. 6e 0 / Lot(s) O Tract t Service Address' " G.A. Code .❑ Meters) r. ❑ Service(s)°- '- ❑ Backflow(s) House Laterals) ; QQ b ❑ Date ctorCheck(s) ti{❑ Meter Surcharge 1 Sanitation Capacity Charge 4' ❑ W.S.B.F.C.. ❑ Temporary Construction Meter ; ❑ Turn on Charge " ❑ Uncollected Account - Name ., t r• ••,JJJ ❑ Inspection Fee - Tract - Fee - - ❑ Plan Check Fees Water / Sewer - Tract - a ❑ Bond Payment A.D. - Bond Assmt. " ❑ Customer Deposit ❑ Other TOTAL �"Y`', IV�J - • x Remarks: II;iI. ' .c%i�d� / 1l Di?i .°❑Copy to: 1,,A' rel ( 5 Cash Check /r.J� J y� Water Service Mone Ordery Cashier f� .:. CVWD-43t311 /89). - Flood plain plan Plans resubmitted Ntcchanical Grading plan 2"' Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.n1.1. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- ''' Review•, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.1.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees