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9810-138 (SFD)U) (V � W O M t`0LX) W o Z It - 0 °o HCD LU Lu Z cY) LID N ON Q °) Q d — `rQcc 0 LL xw_ m U U O 0 I'd, Z_ ob Z) �0 Q J Imc-q- 16, 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 ate 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. 1 have and will maintain workers' compensation insurance, as required by S ction 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 � rb 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 i I shall not employ any person in any manner so as to become subje workers' compensation laws of California, and agree that if I should subject to the workers' compensation provisions of Section 3700 of tl C de, I shall forthwith comply with t hose provns. te: :t+Applicant- 10—- Warning: Failure to secure Workers' Compensation coverage is unla shall subject an employer to criminal penalties and civil fines up to $10 addition to the cost of compensation, damages as provided for in Sect of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building ar for a permit subject to the conditions and restrictions set forth application. 1. Each person upon whose behalf this application is made & each r whose request and for whose benefit work is performed under or pu any permit issued as a result of this applicaton agrees to, & shall, it & hold harmless the City of La Quinta, its officers, agents and em 2. Any permit issued as a result of this application becomes null at work is not commenced within 180 days from date of issuance permit, or cessation of work for 180 days will subject permit to carn I certify that I have read this application and state that the above inforl correct. I agree to comply with all City, and State laws relating to the construction, and hereby authorize representatives of this City to en the above-mentioned property for inspection purposes. 6ignature (Owner/Agent) 0 Date �« BUILDING PERMIT PERMITN A °°NTR°`# DATE VALUATION $250,795.20 LOT, TRACT 28492 J06 SITE- � APN 71911-4 40-1026 ADDRESS _4 OWNER CONTRACTOR/DESIGNER/ENGINEER ��s e: a t c•sr � 0 T'r,0 TRAN18 WM,, !.40L1S %1G !NC SAN DIEGO C.A. 92101 LA QUIN'lA CA 8225: C'�C 11771:- t IRN 4372 USE OF PERMIT SYNCU, FAMILY DWELLING RM, LOT # 40, PLMN4 3C, ITRRAU T tOCl.F S NOT 1ivi,`L1JUE' ,t3L0C X iUJVLL OX POOL, P.L,% 04�X,-K17F rc KDkf6">fW BY 75"m OR. IN'suANC;l CC SAINtE; PLAN ` 7YPk . caisi'C➢T4i coN3 sm-wcaciid "x.0,13,010 S r i?O12G10A. ; 0 323MO 8 iJtll2t'�.r3.�}�;11ti.11%ti�'t' G{N),,+i{J Sty L. itr.d0- e..'43'«9r.i OFi.-6.fJ �iS Y..e'*:'J!�rTION 11,5 ,'"Y95.20 �+ CE,,E88•%..l..l�v.l41. i� INSPECTION RECORD - OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Slab Grade Steel 3' /Lj/f�/g Underground Ducts Ducts Return Air Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Insulation Fireplace P.L. Vents Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wali Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVAL/S 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 _ �� Q �_ 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 6 Appliances Final COMMENTS: o 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)