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0005-208 (SFD)LII;tI4JtU 4.UV4 I hAU I Uh UtL;LAHAI JUN I hereb 'affirm under enal of e u that I am licensed under , rovisions.of '` BUILDING PERMIT ERMtiT�+} > �� '•, } I ,* „+ ,I P rn �,,.iaz t.y.,�,Y ,^iia ..� � � •. to •`': Y P hr P d rY. P. - ,'' 7 F- Chapter 9 (commencing with Melon. 7000) of'Divislon'3 of the Business and r .~ L ,{. ,•4 * - Q00SZOlB `�" r ":: ' DATE VALUATION 9-i.? LOTr t TRACT .,�• ti e W Professionals Code; and my License Is In full force and effect: .4 K :•}IQ4�757.90,,''f . 'License.# I r UC. Cleae l Deter „,x *' Q 1 / S JOB SITE ; i ti �, ► y. t + t. APN UJ -ADDRESS, �, 1. 697117 a x'} r+ { *'BHIC ' 0 ADDRESS•. '" 1;' 7 34 CALIX PAI.11+i8"i+0'° : X04 3�8 Q30 j Z Date �Z d�., Signature 0} COntract0 OWNER i t CONTRACTOR/ DESIGNER / ENGINEER ' F ;OWNER BUILDER DECLARATION= ;M' f "+bLii?2iAN'TAND VIIILT.II�+4FA98( ,INC: "'� bixP 1 AND WI �.tAt�d9 ASsoC'; we, , W W : I hereby' affl,nn under, penaltyof perjury that) am exempt from the Contractors'77400 Ati MM..0F1iiB 9TATB1� .. 77.900 AV}�1UE Oir IM STA37W . ,.. : license Law for the following reason r: ;.. F PA IASPRT CA • 92211 'PALM`DESEIZT Z (') , I;;as owner�ofahe' property, orsmy'employees with wages 'heir, (?60)343 x626'• CBL# `5103 compensation; will do the.work; and•the structure, is not intended'oroffered for "sale: (Sec, 7044, Business '& Professionals Code).', , �; USE OF PERMIT �• :( ) owner-of the property, am,exclusively contracting with licensed contractors"to consfnict the -project (Sec: 7044, Business & Professionals . 9IW=FAMILYDWELUNG • Code).' ,: , ` . ti . •. ': ,. : , .:. , O',I am'exemptundor Section `' B&P.C. for this reason l ; SFD-LOT 12t ;PLAN 1AR I.PERMIT DOES NOT *CLUDE BLOCK' _ ' w Date Signature, of-Owner f f OR'POOL. ALL OTHER PTdRMITS REFLECT 739 REDUCTION TO PW►N Q r C_ ECK PLE hOR MULTIPLI ISSUANCE OP SAME PLAN TYPE +;C—U�,WORKER'S COMPENSATION DECLARATION,%-: Q �,I hereby affirm"under, penalty ofY perjury one "of, the' following declarations: U); "' (J'1'1 have and will maintain a.certlficate of consent to selfRinsure.for workers' TRACT. CONSTRUCTION: 1.736.00 SF „ I 1: X', £ ,compie satlonr 'as provided. for'.by Section;3700::of the Labor Code, br the ' PORCH/PATIO 3$ 00 S>r QQ J ^performance of.the work for which this'permit is Issued: s; OARAOZICARPORT (SF) by ave arjd,will' malritain workers' compensatlon Insurance, as required � Section;37 of the Labor Code,',br.the'performance of the •work for which '.this .+` t 0.,"� FQ-i permit is,Issued..My workers,compensation Insurance'carrler & policy no are: j , Policy No k b t f 1$fiATB.PiTNL1 �5"-•: S - X67-99 M.120 ' , . ,. '���� ♦. �SvSIT]D►EAT= GUST OF CCNS'T i l'l ' 1!01' > -1 " (.,� 104,'757" t 1•J+ � �Jf.1SarlL1 Dp.ld•O VA'J�JItI�Hit[ (This sectlon need not be completed If the permit valuation 1s4641'00.0 or'less)'. ' ' I CONSTRUCTION FEE 101400418-000 t <: WIN I , z �� ,x, (• )',I certify that In.the performance of the work for which this'permit is Issued, «'. I shalFnot employ an y'subject"PLAN CHECK FEE - ]01-000-439-318 :140 IID ;;workars;compensatloiipaws�of California, and agree that ifrl should become , MECHANtCAl:, FEE 101-000=421.000. SA7 ao _subject to the workers'`compensation provisionZfS ctio 3700 of the Labor, ` ELECT R1CAt A`PJ$: 101-000=420=000 441 Code,I tlfowlth,comply�wi t royi . pLUMbMOi+EE 101+000.419=000 Date A Iica + STRONO MOT1oN'P`BE • Rrsln' - 101-000=7a1-000'•' Warning: Failure to secure Workers' Compensation coverage is unlaw[ul and aRADM© FLE 101*000-+423 000:.. :shaltsubject•an e'mployer,to odminal penaltiop and civil fines up to $100,000; in D1SVP,LOPL�R IMPACT FF.E X1,90700}. r r t " : )addition to the cost'ofcompensatlon, damages'as,provided for in Section 3706 ' .of the Labor Code, interest and attomey's fees.: •' ;+ . IMPORTANT.°Applicatl'$n is hereby'made`to the Director of'Building and Safety for .a permit subject...to'the,„conditions :and restrictions set' forth on his i*. E application r c.l.. y+ r n a . ' 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 toSIM-TOTAL CON9TRi1 ON AND PLAN Ci C• -53,068.60 r ' , any permit issued as a result of this applicafon agrees to,`& shall, indemnify �. L1l8S PRB Pt�1D FBF.9 $0.00 &hold, harmless the,.City of La Qulnta, its. officers, agents and. employees. `2 Any permit issued'as a result of this application becomes null and void if � , TM4 P1 MTT FEi�bl DVE NOW 53,0156 �o work is not commenced within-180. days. from date of Issuance of-such p n 1 ` permit; or cessatloh*of work -for 180 days will subject permit to'cancellation. �F1N-^� 2 2001 . r I certify that I have read this application and state that the above information is correct I' agree tocomply 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 ins a tion pu os t y RECEIPT DATE BY' ' DATE FINALED INSPECTOR kr r' Signature (Owner/Agen DateJ/ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 1719Underground Ducts Forms & Footings Ducts Slab Grade _ Return Air Steel Combustion Air Roof Deck Exhaust Fans O. K. to Wrap f15 F.A.U. Framing 110 Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath k Drywall - Int. Lath Final Final 7 o L BLOCKWALL APPROVALS POOLS -SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines se Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans�� O.K for Finish Plaster Sewer Lateral t Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Q 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)