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0106-098 (SFD)I—. . V t) ( W . O :D co W r o Z l� Zo O o H� J Z M L0 N ON U °) CLs Z a 0 0 J J mUU O MH It Z_ ob5 r-0 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 f -=�'�-Y— 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 sof 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. STATE 1 MID 017092-0 (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. \/�j� Date: r t � Applicant �. r`% ' t t�, wog } - 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 Whereby 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 aeresult 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 for inspe tion -purposes. Signature (Owner/Agent) w�' t +�'� IIS Dati., -- of BU:IPING PERMIT PERMIT # �►/�n'l DAVE VALUATION LOT TRACT 1=39111 60 6 JOB SITE APN ADDRESS % GQw. �)�' �i.:� 5 OWNER CONTRACTOR /DESIGNER / EN ]NEER ,13400 t31P IM.. . A.V}!.Jxe UE = 325 4400 CE TM.r.AV�"�' a ISM 325 ki;01,FR=R CA, 92506 T IVERWID.RK' CA, 92506 USE OF PERMIT H,I~401ZFm. MyD-V k113 3400CZNTR.A.L.A'1PMJUESTE325 I?D -1,0T 64, PL A14 `., PEW.F&F DOMI NOT 1N%=UDZ HLOCK WA„L.1., POOL OR. .t RJVZNVAY, .PPROACH. 'h% UMUCTION TO PLAN CHECK FRE APPL,1FD FOR M..l,71.TYPL1a SUBMI ' xAL OF U M PI, AN! TYP& CUSTOM C;ONSTRi IC`',ION 2686,00 SN 1iCbCLC1;iIPATIO 324.00 SLS CE,ff.,iiAWC;.ARPORT (SF) 10.584.00 E91. 1L117W C06`1' OF CORS)",Ri3criollff 23917 n;ZIM) F%`RW'f WIRE R fps AR ` COMI TRUCT.1013 RE 101.000.418.000 $1,129.50 PLAN CHECK F&E 101-000-439-318 $230.37 MAE t 1MI «1 A.&, YZE 101.000421-000 $31,50 1;1XZT1UCAL 1M.. 101-000-420-000 $164.33 P1,A04'DING F9F1 101-000-419-000 $131.1n S'1'RaNf:4.MOTION PEE - KESW u47t30-•241-000 $23.9 '1 �0 q}. T-D�7.?1J. NG naw• ! 01 "��aP0-423^000 G9 / 4 0 INFRAxT.RUC`1URC:'r'"1rZ 225-000.443-342 pporno ART I',iLT P'UBLIC.'. PLACES - RAIL `Itl'3�CiC3C6'25 salJ0i7 $AS°.^s8 a 01{ ^'A'a rAe. C0Y4tTJVC Chi i� A14D PLAN ( CK $3�, • 1:� _. MB ;C' P .ED $0,00 Jtlf� 1 5 20L'�a°1, ' lents! E N01 V S3 MAI CIPS or IAUUINTA �Ir�A,iL D.Pr RECEIPT DATE. BY DATE FINALED INSPECTOR 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 _�Or p _ F.A.U. Compressor__-_ (� Framing (__ �j( _ 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 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 r Sewer Lateral /, '� - �!� ��t 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. Smotie Detectors Temp. Use of Power Final Utility Notice (Perm) F/7- 2-'-?- -ja4b. p s lz CITY r BUILDING INSPEC SHEFFIELD Owner Co actor SHE, FFIELD Permit Nu"Zor 0106-0� POST ON J08 IN C INSPECTOR MUST SIGN JOB ADDRESS r79-92U SFD -LOT 64, PLA1 NOT INCLUDE I3LC DRIVEWAY APPRC TYPE OF INSPECTION FOUNDATION 8 SETBACK FOOTING STEEL MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE 00 NOT POUR CONCRETE UNI C.ONCAETE SLAB JOISTS S GIRDERS ELECTRICAL GROUND WORK --1 - c'! DO NOT POUR CONCRETE LINT ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS 8 GAS TEST HEATING & VENT • A/C FIREPLACE ROOF BOND BEAM OX TO WRAP GROUT O 4' © 8' FRAMING INSULATION PRE -ROOF COVER NO WORK UNTIL I DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE a GATE SEWER SEPTIC TANK FIN/ ELECTRICAL PLUMBING FINAL GAS TEST HEATING • A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABOVE APPROVALS DO N TURN ON UTILITIES OF 90'd T8bOb9S09LT LA QUINTA F�yEDEPARTMENT* IDEPARTMEN* '/ ' -/�y0�` 4 REQUEST LINE 7-7153 viES vlES MCUOUS PLACE . APPLICABLE SPACES RUS It - PERMIT DOES WALL, POOL OR H ICLUDE RIGHT TO UPY BUILDING snNiI3lIAON1 Wv tb:OT ZOOZ-60-NVr