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0101-282 (SFD)� W F lM W oZ� � 0. 0 J I- (D F -a U) Z M If) N ON U (3) �a Z Ix TIa-O W X W - O M. -' Q VU O rn H �Z : T° d 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 Date i ;— Signature of Contractor 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. VTATIF, YUND 15 Ib #1: lib (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•cif Section 3700 of the Labor Code, I shall forthwith comply with those'p,rgvislons)- Date: (+� `tjf} Anplirant '3rr�ai 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 arpermit 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_'f6-r inspection purposes. Signature (Owner/Agent)' + Date BUILDING PERMIT PERMIT# DATE VALUATION LOT _^ TRACT {f JOB SITE ( APN ADDRESS 79-K40 6."1rT'f iS 7r'v}7- � d ►€4t: OWNER CONTRACTOR I DEIFER A3IF 2 z 710kas 81MdF'D J70SYx1:81 wa f?U C41'hKL AMTO , 72,3 2 .3400 CEMAL A �; LIE: VIE 325 RMUTD1' CA 92506 RMWIDE CA 92506 (909)6$2.5 52 mvi 5386 USE OF PERMIT r , .01).. PfAi:2ulC,CT::55-PFRUITDOEodCf114CLUDL " Jen.3L K rF4 YA,0( //A14/PL0nfJVAiRIAPPROACH, ":© PLAN 12EDVC'I ION MPLNUL171171LZ 183UP.1ICIE OF SAM PLAN 'i'YPF., 4KHTOM CON33T RY3CTION 7,826,.CeO 8F FCj&1�P[•'.F►`I` o 324,00 SP .w -v ..ar rusI1 4.7:w Con off' con glr2i1Cam 23,9,712,60 PKRW1; 009 UMi l0 ARY trC NSTRUCTION FZF 101-i 00-418.000 $1,J29"m PLAN CHLECK FER 101-000-439-319 5730.37 MECI),l NICAI,b'WE 101-000A21.000 05.50 I:Ss.L:CTIUCAL f1fir.: 10 1 -00&.42,0-000, $11AJt INAIU1:k1;X0 P,111 101.0004419-000 $1211.71 T .ONO A1•i3`,I°IOW. '' T7,PH - RE.111) 101--000-241.000 $23.017 GItAMM FEE 101.000,423.000 120.00 '1'tirlMA09'I'3I,IUI^.7'M Nl�Y, 225-000-4-4.3-342 "r3-342 1±1,907.00 ART IN 1''USUC PlAAC- .,3 - IMIr'701"000-255-OV) $90,23 SUP,'. r C;{?rrfiMRI.1'C1'ION AN:0 PLAW C'.f3c''r;C."K $3,841.68 Ic ,+ 1�, RECEIPT 1 DATE f 1,. 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 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 Lines2s��� ��� 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) *OF CITY OF LA I BUILDING & SAFETY P T 777-70 INSPECTION REtd)ES. .vLIf 777-71 Owner SH FFIELD HOMI& Contractor SUggriiFT n HOA4ES Permit Number 0101-282 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES JOB ADDRESS 79-830 CITRUS SFD-PLAN 2BR LOT 55 -PERMIT DOES NOT INCLUDE BLOCKWALLS/POOL/DRIVEWAY APPROACH TYPE OF INSPECTION DATE INSP. FOUNDATION & SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRDERS ELECTRIC GROUND WORK DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS & GAS TEST HEATING & VENT- A/C FIREPLACE ROOF , Q BOND BEAM O.K. TO WRAP GROUT O 4' O 8' FRAMING -cf e INSULATION -- d PRE -ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR • Cr( EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SEPTIC TANK FINALS PLUMBING l FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER I ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING