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0008-364 (RPL)IS LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Ckapter 9 :ommencing 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 6385.45 B 8/21" r� L � t/ -f7"ateSignature of Contractor ± OWNER -BUILDER DELL RATION"�.'�c����ffT I hereby affirm under penalty of perjury that 1,6m exempt from the Cont"ract6r's License Law for the following reason: l I" ( ) I, as owner of the property, or my ,' mployees 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 STATE R.IND Policy No. 229P9-0009671 (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 thpT if I should become subject to the workers' compensation provisions'.of Section 3700 of the Labor Code�.shball forthwith comply with the r,•vi ks�. Warning: Failure to secure Workers' shall subject an employer to criminal I addition to the cost of compensation, of the Labor Code, interest and attorn IMPORTANT Application is hereby for a permit subject to the con application. cer gInlafufipensation9Gan ItWd ties and civil fines up to $100,000��n ages as provided for in Section,1706 fees. to the Director of Building and Safety and restrictions set forth on his 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 hate laws relating to the building construction, and hereby authorize repr sentatives of this City to enter upon the above-mentioned p pe y fo ns�c ,�pu 1 s � �� Signature (Owner/Agent) . 1 /Date 02-1'' Z' , y J It( ( Tool BUILDING PERMIT •PERMIT# DAT t� VALUATION LOT 00W364 TRACT 89 L111 JOB SITE ' APN ADDRESS '78-620 SAGUARO 649.-:31:2-039 OWNER CONTRACTOR / DESIGNER / EN (NEER LEONARD I" IMMEL V,EN'1°ITns a .PO BOX 450 /8-080 CAT 1Y, FMADO, MWE 204 %,A QUWrA CA 92253 IA QUINTA C A , .9225.3 (760)564-1866 erl'Lff 859 USE OF PERMIT POOL, AND/OR SPA POOL &SPA ONLY•A.LA.RMSMARIt1ERS SHALL 8E IN PLACE ,AT PRE PLASTER INSPECTION, POOL EQUIPMENT ENCLOSURE IS NOT IN(!V(JDFD IN THIS PEItMT POOL ANWOR SPA 11,DDD.00 LS ESM CO3"r OF COM�c'UMON 1110D0AV PERAW FEE HilMl 1AR.Y PLAN CHECK M 101.000.499.318 $31.90 CONSTRUCTION FEE 101-000-11163-000 $126.00 --A�EC1iAN1CAL FEE . P©OL 101.000.421.OW � $24.00 EL9CJ'RIC.AL,FZE -- POOL 101-•000-420-000 $45.00 P , MBING FEE Pool, 101 -WO-419-0(b ti',40 AIG 0 x^_23 0r' -"L-A' QUINT "ATS' OX 1�OTAL, CONSTRUCTION A14D PLAN' CiFyCX $303.90 g LE 3.9 PRF PATO IMS u $0.00 TU9.AL Pte' r . , .t ; DUE NOW is = K \ RECEIPT DATE / ,BY DATE FINALED INSPECTO _ INSPECTION RECORD • OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR . BUILDING APPROVALS MECHANICAL APPROVALS A 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 , _ �,✓�— �i Underground Plbg. Test Tp'-e— 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) dX E.[D'- F?OOL FO,FR;_ NAF4, 8i7 IVC: =t:S-EON•^FIE> L1^ 1I. 78 - zv Sa 4w' UA +eo i vE- - 14 F>d I Z • an 3 cr CITE' OF .LA QUINTA j - A. REINSPECTION ffE OF BUILDING & SAFETY DEPT. WILL BE CHARGED IF THE APPROVEROVED PLANS AND JOB CARD ARE NOT ON FOR C N TRUCTIO THE -SITE FOR A SCHEDULED. INSPECTION. BY NO EXCEPTIONS! oATE