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0302-084 (BLCK)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Fes- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N W Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date dr W 463407 C29 B 0191.130 i C Z ti Date!'%=' '= Signature of'Contractor O �- -- r` F- CIDOWNER-BUILDER DECLARATION Ha I hereby affirm under penalty of perjury that I am exempt'from the Contractor's U) License Law for the. following reason: Z ( ) 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). ch O I am exempt.under'Section , B&P.C. for this reason LO N Date Signature of Owner O C4 CD d Q WORKER'Sr COMPENSATION DECLARATION '� pZ 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' X. a 1' u- compensation, as provided for by Section 3700 of the Labor Code, for the 0 J performance rformance of the work for which this permit is issued. 1:0Q U ) I have and will maintain workers' compensation insurances as required by d Q Section 3700 of'the Labor Code, for the performance of the work for which this d H permit is issued. My workers' compensation insurance carrier & policy no. are: Z CameyaCiUUR`'icuq�'IVi EtiF t Policy No. } Co �a g (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, 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 thosel provisions. .Date ., : %� - Applicant Warning: Failure to secure Workers' Compensatipn 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 fora 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. l 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 forr,,inSpection purposes. -Signature (Owner/Agent)Date,,,:-' BUILDING PERMIT PERMIT# t�3�'3r;L-t)4L•�i DATE. VALUATION LOT TRACT t r:�l.0 x l.�flf, 5�1,�'�GIDC1 JOB SITE - APN ADDRESS 5.1_4,10 OWNER CONTRACTOR / DESIGNER / EN (NEER t9.t�1 f)Y iMa`Y)ER PDRUR'r C0x .r4R lJ T..I.0 52 -440 DR, G,p,I-0 ,7 RIV L 7 3kKIP MMISt N "Y'r 1A QU1I T1A CA 92253 PALM DR111MT CA 92215,0 (-160)�I46- 1227 ('I3'Uf 04554 USE OF PERMIT 1810 LF, 4' OAR, al 'W.A.IJ, 120 L.F. 780 PLANT= 8` t -d lw BOTH ORC0 0Y13TE,M G FT. WALL 19E1 LIG i.>r F`s. MOZATFI) COSI' OF (110K i'%R`C7t~:°;i7iON 4,5M.00 I:'Ti ici►✓li;il' FFF 911MII/ltS.RY CCxiJS')'ItifC �iO�f t%1!3� 1 t)]-QtI>t�al �-th�p 3"!1,(1!) D Q FEB 1 1 2003 CITY CW �A QUIIVTA FINANCE D r SUB -If GTAL r. ON91MUC`Izf,W AND PLt'iU CF)FM tr/2.00 RECEIPT DATE BY / DATE FINALED INSPECTOR INSPECTION RECON® 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 BLOC KWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam , 03 Approval to Cover Equipment Location Underground Electric Underground Plbg. Test 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 A 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)