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0104-292 (RPL)LICENSED"CONTRACTOR DECLARATION I herby affitr-A under penalty of perjury that I am licensed under provisions of Chgpter 9 (commencing with Section 7000) of Division 3 of the Business and PFofessionals Code, and my License is in full force and effect. License # Lic. Class F�xp. Date a" to Signature of Contratop M� N ,t 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 workfor 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: Cartier 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 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 wit those provisions. e� Date: U/1'71LI Applican / r x -LO, . �... "' earning: 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 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 construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspectio%, urposes. , 4ture (Own er/Ag�tj 1 J r� sf` Dafe r . . 7 BUILDING PERMIT PERMIT# DATE VALUATION LOT 0104-2(Y2 TRACT $15;440M JOB SITE ADDRESS APN ,5 AVr'A XtR — •° OWNER CONTRACTOR / DESIGNER / ENGINEER 54,785 MINIDART&A.M7, I.A sk�1:e�.�:jT.A. CA 922,5� P:A� ��� 'I CA 922160 (760)341-0117 119 6211 USE OF PERMIT PE 0111M/OR ?A: I :%tJVIAS'P1';_ .A.L:,A.RU.1 SA ';fait!'£";$.," SHAT L BIP. IN PIA E.', Al PR1e,;%A:° TXR , 7NCI>t3fri'MINIVE,S'9ICATION P°Z 199'"i'UN RX / I'0011AND1011.S:PA W10 111-y'r AATIM c00,11 Cert +C.'Cl S'�`.l�UI;":;6.100 1� +f�tiPfb ffummwv PIAN CRECK Val 101-000-439i,31 6 �I9I.a Cy09,11TRUCTION FEE 101 -OW -410.000 M'LCkTINICA1, FEE, .:. POOL 101.000- 21 • M &Z4.00 P. LECTRICKL D -a 3001, 101-000-420-000 $45.00 PI.t:JMMO 1paw, -- I'C,K)1., 101 ^W0L-419-(F:IU 3".00 CONST ItUC i'I€ N ITE 101 -fl-41$-CM $17.1iog .� h _ NAND RLAN CHMIC $549, 15 0 LESS PIRF.pPrID MZ D. $0.00 a ' APR 2 7 2001 CITY OF LA OUINTA FINAPirc RECEIPT DATE FINALED INSPECTOR OPERATION DATE I INSPECTOR OPERATION I DATE I 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 Wali Insulation Condensate Lines Party Wall Firewall _ Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Set Backs Steel Electric Bond .� �4 Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Final PLUMBING APPROVALS Underground Plbg. Test Gas Piping 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 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) jo 5' A RE -INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SlIE WK A SCHEDULED INSPECTION. NO EXCEPTIONS! Z�l�/V21Z CITY OF LA BUILDING & APPROVL F6R CONSTRUCTIv '� DATE fin 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 -PPofessionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date" A, f� ' 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 9f 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:. Policy No. Carrier :"KITH a 4d�SfSt�i 9 (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` Date: - lo - d,., Applicant— Warning: pplicant Warning: Failure to secure Worker§I ,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 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 construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) fy`%'✓%��f Date"'- 5 Zq„, BUILDING PERMIT PERMIT# LOT �a TRACT DATEVV�A�� /y g Lin p��L-UATION JOB SITE ADDRESS -785 ANY'RUWAAJ9M APN r - OWNER CONTRACTOR / DESIGNER IENGINEER 54-r85 AVEITIMA aUZ 68-200, BELL PAVETA LA YTi +'. 'A: C.4 92253 C:x1IREDRAf..LTry- CA 92234 D CB14A l (W -4510 USE OF PppE�R7MIT,�O\'��; /7 CPow,AA NOR SPA Lx, PFRAW.":I'i'i' RO'fYARY SUPPIAMMAL PERMIT FM 101.000-4'.23.000 * ITY01FL:A1��il4 1-11 �F�: NCF { ' TOTAKTI MAZA T11 '' '` '. ITIE NO $410 RECEIPT DATE BY f DATE FINALED INSPECTOR INSPECTION RECORD OPERATION I DATE I INSPECTOR OPERATION I DATE I 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 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 Lateral Pool Cover Sewer Connection Encapsulation l� Gas Piping Gas Test Appliances Final Z O Z 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)