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9907-559 (PAT)LICENSED CONTRACTOR DECLARATION I here�y affirm under penalty of perjury that I am licensed under provisions of Chapteir 9 (commencing with Section 7000) of Division 3 of the Busi , ness and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date ,6916PA 6 . �,p 4t * "'llell- ignat ure 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 reasow ( ) 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). ( ) 1, 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 t,he following- declarations: ( ) I have and will maintain a certificate of conient 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 perm it is issued. 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. 1�y workers' compensation . I . nsurance carrier & policy no. are: Carrier Policy No. "TAI %. AM 145 RZ (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' compensati6n laws'of California, and agree that if I'should become subject to the workers' compensation provisions of Section �7.00 of the Labor Code, I., hall.forthwith comply with tt(ole provisions. Applicant— Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $160,000, in addition to the cost of compensation, damages as provided for in Section 3706 . of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject 'to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant -to any permit issued a s a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if. work is riot commenced within 180 days from date of issuance of such permit, or. cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon , i the above-mentioned property o inspection purposes z.,,qate Signature (Owne.­.Jum),� V PERMIT # BUILDING PERMIT 91*745W DATE VALUATION ,S2.83.? TRACT '.9() LOT 6 - JOB SITE! APN ADDRESIS OWNER CONTRACTOR DESIGNER ENGINEER 10 ]NCO HOIMES CORP. _)VIONMESCORP. 1242 W. ARROW HWY 1282 W. ARkOW 14.W UPLAND CA 91795 UPLAND CA 908-1 (W) ) 9 1%, 1 - 8 10 8.9 3M USE OF PERMIT 215 S1. OPENT k M -f SIPATIO COAfER PORCI-MIXT110 14, It 1, q1PJ1 S). '. CONS'ORLA-MON M 14)1.AXA)-41-$-4)00 8540i PLAN CREM, ` FEW,' S�%SA0 51-11 STM -TGTA, U f 0 N 9 M U(' , TR3 N AN r) P L. A N (-,f 4 F C I � . LESS PRE. -RAID FEES TOTA 1, PC' RIM IVY FIEVS 4) U E N I OW RECEIPT I DATE I BY FINALED JINSPECTOR i 0 U�9.66 INSPECTION RECORD OPERATION I - DATE I INSPECTOR OPERATION I DATE —TINSPECTOR 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.C. 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 L ataral Pool Cover Sewer Connection Encapsulation Gas Piping 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: