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0207-028 (PLBG)U) w U (V LU O n M CY LU r o Z CZDOO J �CD LJJ LU f� I-- a Z M LO N ON U °) Q Z T Q O X Lu — mVU O d rn H ,ItZ ob �5-y V J 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. License # Lic. Class Exp. Date 554 B C36 /7 . , , 1/2( '� ✓ Signature of Contractor, Ziff ` 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. ()4.), 1 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 �s:p 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 with those provisions "I' Date: �` Applicant s- �- � fir; 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 fof iinsspectt[on purposes. Signature (Owner/Agent k i ' � ✓� 'Date2/'S "'?` r� S ILDING PERMIT I �T RM'T# 0207-029 DATE ;A)8fZM VALUATION $151 W.W LOT TRACT JOB SITE ADDRESS ;� :} A�ANUA�Z pY{�N APN OWNER CONTRACTOR / DESIGNER / EN (NEER Sx7(:'VZ4 M DAWS R Y S CONSTRUCT101I & DRAW SPHKM 3ICII� 77-500AMMAF-MIANDO 82)54 T141Q13M,AVE LA (411IN'TA CA 9221'j I,ICI0 CA 92201 (160)342,,9175 CIBIJi 559 USE OyF'{ PTERMIItTy (yY 'S.�i. 103D.1.�MO SEPTIC ADANDONIMNTIS'LVER HOOK-UP. VALUATION opp'(10 I's ES l"T ATM CO 1 OF +C()NS' RUC'.!'((.)0 151,099.001 1113n R ►I, r11 WE Kllat'.tiV3ARY pl lij }:f1�1t } Ir it ?F.l�. 3011-000-41)9-000 ,ItI1_ CITYOFLAQUI(wTA FINANCEDEPT: i SUB-79TJAL CO Nfi° UCl` ON AWD 3'I,iAN rl~I17.CK $30.00 T'RU-PAID TaM $oxt 7 TOTAI, PFAMIT lFE7.1f; IYET :1110W Vvtx) RECEIPT DATE /r, BY, �" DATE FINALED INSPECTOR /�I 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 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 Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection d O Gas Piping Encapsulation Gas Test Appliances Final 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) COMMENTS: Bin # City of La Quin ta 80ding ar Safety Division P.O. Box 1504, 78-495 Calle Tampico Permit La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Addrcss: ���r�Q ��. J�� CV u Ov mcr's Name: �'+Cd cj M, A. P. Number: Addrcss:. .0, Legal Description: City. ST. Zip: 0/0z Ayl Cl eA Kdl ontractor: , ddress: - � y Q(� (�� Project Description: in. ST. Zip: ��Dl 0 Telephone: 2U O -3 7 - 7,//% 1 State Lic. # : ��D���T ;Croy Lic. #: Arch.. Engr.. Designer: Address: City. ST. Zip: Telephone: Construction Type: Occupancy: State Lic. #: Project n,pe (circle one): New Add'n .alter Repair Demo Name of Contact Person: L�� Z�� Sq. Ft.: #Stories: #Units: a Telephone # of Contact Person: � Estimated Value of Proiect: APPLICANT: DO NOT WRITE BELOW THIS LINE tt Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2" Review, ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees e JUN -27-2002 THU 01:5 2 PM ABRAHAM & KENNEDY-ERLQ FAX N0, 760 777 7629 COACHELIA VALLEY WATER DISTRICT CC��ElPr DETAIL �l'brc..hca,rn, 090114 P. 02/02 Addresa..—> 1 5 — 3 1 t QCT �i t.��l C `i cv �. -- - -•--- Account No. ' �_ _� Lots Tract_r— Service Address_ Jt�7 ?I`r"1 1 r i1 �'� Q.A. Code UJ Moter(s) House Laleral(s) � JS �' d F) DetectorCheck(s)��— Ll Meter Surcharge Capacity Charge Ll W.S.B.F.C, �- -- — — ---- - — U "temporary Construction Motor — — U Turn on Charge 0 Uncollected Account - Name._._ 1.1 Inspection Fee- Tract • Fee - — -- --- — 0 Plan Check Fees Water I Sewer Tract - _-- U Bond Payment - A,O, -_--Bond _ 11 Customer Deposit_. r3 Olher---...--•----.__.--------. t ...--•----•----�t�._.._—_� _ t� TOTAL = �I L+�S Remarks: V�Gopy to: — z t� i l��- Cash Weler Service Money Ceehier Order - -- • 436 (1 i 188) e I� • bz.a f,14vs Gvls+n�c+llon tjj 1 �.1e— 0 6202 028 _ E;r Oob -a+ 72-S00 AJCt'ic ca �Zrnart.JO. ta�+ G its discot-41nv'�.�t_ I �•Q- to o .� � C.� 2 ✓' j tv2 � � tc 1'ti/1 S-�i � � � C� . �Y � � dun �'�- • � irk a,S �,O'� f10'�'i'�1 e - - �� ��/- �oc�,•�y�c..��-- or ► t�.�-�7yr 'lam �Q�-T�v4.U�. Off' �.(.,SCO/I'TG/.11.� s � N iP'�l�ar�r�'►��1 d��' o c�.c/ _ rev � v��.tv�c��.���`y ol_ 51 ry �pnj 4 v49 �S'eo - �-. t 1 ` . _ ' _ O.. I`l _ I i2�1"�''' -.. , S -I �V'� �'�J✓� �'u�✓' 7�"6 Cal - - ©17Z C) ocn _ -CITY -OF-LA 00INTA ° A6 ® 5 REQ ----- - - 4** BUILID INVG BIND. SAFE tj� 'QF LA QUINTA. & SAFETY DEPARTMENT ,,--f77-7012 CTION REQUEST LINE a 777-7153 - Contractor R Y S CONSTRUCTION & DRAIN SERVICE Permit Number 0207-028 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 77-500 AVENIDA FERNANDO SEPTIC ABANDONEMENT/SEWER HOOK- UP. TYPE OF INSPECTION DATE INSP. TEMPORARY POWER SETBACKS U/G PLUMBING / WASTE U/G ELECTRICAL/ GROUNDING FOOTINGS /STEEL CONCRETE SLAB DO NOT POUR CONCRETE UNTIL ABOVE SIGNED OKAY TO WRAP FRAMING COMBINATION ROUGH ELECTRIC COVER NO WORK UNTIL ABOVE SIGNED INTERIOR GYP. BD. (DRYWALL) EXTERIOR LATH GAS TEST SEPTIC ABANDONMENT SEWER SEPTIC / GREASE INTERCEPTOR MASONRY INSPECTIONS FOOTINGS / STEEL BOND BEAM POOL / SPA / WATER FEATURE INSPECTIONS \� PRE-GUNITE / SETBACKS U/G PLUMBING U/G CCAS U/G ELECTRICAL PRE -PLASTER ALARMS / BARRIERS FINAL INSPECTIONS TEMP. USE OF PERMANENT POWER ELECTRICAL PLUMBING MECHANICAL PUBLIC WORKS DEPARTMENT COMMUNITY DEVELOPMENT DEPT. FINAL / JOB COMPLETED ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING 0 CITY OF LA OIJINTA AUG m 5 RECO