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9806-212 (SFD)(V W W o =) r) CY ' W oZl� Zo0o H� r` J ~a U) Z CO L0 N ON U °) Q Cr Q O QUJ LL J J m U U O 11 rnH `t Z_ ob Z) �a Q J 1 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 743109 - 1(99 ,/ate dkg Signature 4of.Contractb' r .''""—"' 1 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. STA11 UNO 035-97-fwu 123E (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 'G700 of the Labor Code, I shall fo'rthw'th comply with thosp ovisions'.'- vDate: '�'/ rdApplicant_— _71 ✓" Warning: ailure 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 attorriey'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 L construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection puiposes. // .r_.....-, - /ignature (Owner/Agent) s —. d'" Date `— `�, _ # CONTROLk BUILDING PERMIT PERM' 1914106-2.12. . S DATE VALUATION $2501795.70 LOT 14 `" TRACT ,t� H O o ll�L1 Ri. JOB ( ADDRESS 57,539#�y .OXi©N#A`% APN OWNER CONTRACTOR/DESIGNER/ENGINEER ,k1CC0tv11C;-SE0"KT0P 1;LC T TANS ANT, ST HOUSING INC 750 B ST SITE'3140 78-401 F HIGWAY 11.1 SAN DIr63 OA 9210.1 LA QUINTA. CA 92253 (760)771-3363 CBLY 4972.. USE OF PERMIT SIX, - PN 1, LOT 45, PLAN 313. PERMIT DOES'NOT 11`ICLWE U1:OCK WALLS OR :POOL, PLAN GH (FC FEE RFDUCED BY 7Yle, FOR. NIU(. TTP.LL ISSUANCE OF S.LXNf t'PLAN TYPE. CUSTOM CONSTRUE" nON 3,013.00 SF PO12.<` PAT.10 325.00W CARAOf CAR}'ORT 600.00 SF it"l°IMA TM C(A51'r OF CONWfRILIC110N 2511,795.211 PERMIT FEE, S111V1riLA17Y CONSTRUCIJON FELE 101-000.418-000 $.JJ'63.00 PLAN CI ECK FEE .101-000-439-318 $239,50 iMECHANICAI.1`l{X 101-000-421-000 3124.00 FUX-CrRICAL IFFE 101-000420-000 $114.W& PLUNIHING I771E 10.1.-0001-919-000 $192.50 ST11,0-ING MOTION FER- RES1D 101-000-241-000 $1,115.08 . G.RA3)1N'G FEE 10.1-000��23-000 $20.00 INYRASTRU("i`CV .E .F& 225.000-U3-342 $5,545.61 AgI' Qui PUBLIC 1)1,ACES - RlEsir''01-00X1",^..55-000 $376.39 i { 7 4 S1»r!3-'1YrA;t, CONSTTi.UC710N MD PLAN CHECK $?,fS�sfi,ii7 LESS PRE-PA.11) TI CS $0.010 ", J U L 14 1998 'TOTAL PERMIT FEES DUE NOW $7,966.67 .RECEIPT DATEa DATE FINALED INSPECTOR .0 4 x M 9t• 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 Insulation . 5 _19fr ed Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 16 – —Q Final Final BLOCKWALL APPROV S POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines –RXHeater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral!/ Sewer Connection /� / �� "! Pool ver 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) 12 COMMENTS: