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0301-333 (BLDG)H (V W Cy N C:) Z � 0o F- c J D W W I 1— d U) Z M Ln N ON U CII EL Q LLo LL OJQ C0 _J< O CL: �� ,It Z oo Z) Q J L1L;tNbtU UUN I KA1;1 UK UtULAKA I IUN I herg' ,ffirm under penalty of perjury that I am licensed under provisions of Chaff (commencing with Section 7000) of Division 3 of the Business and Professwnals Code, and my License is in full force and effect. License # Lic. Class Exp. Date '1133152 NWC 04!4)/2C Date � 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.Cfothis-reason Date 1 '°f Signature of Owner It� 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. (T) 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. My workers' compensation insurance carrier & policy no. are: Carrier TAT, POWD Policy No. CW601I.I;Pf}'COtiUU4AI.3 (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 pro, I ions. Date: `%Applicant - 4 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 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 -menti ned property fol inspect'bn, purposes. is - Signature (Owner/Agent) �`^ Dates 7 BUILDING PERMIT PERMIT# ���' DATE ! VALUATION LOT TRACT JOB SITE ADDRESS ._I R.A —7, APN OWNER CONTRACTOR/DESIGNER/EN INEER PGA1, WEST T?.F.MDX,,N- rrW_, A€I80C., ].'NO I`+EL MAR, RM -07C OMw' RX, CONTRA4"''fIN P.0, BOX 1060 250 LAQtTJ3 EA CA 92253 C:L431XPFBY TTT!:3V,, CA 92001 t;lr,`;flj6iS�1fl10 CML# 5823 USE OF PERMIT Cj};.FI.E?�.tA1li. ��.1! 7I1JC4 HL I)0, 36. 1541-:M%900,34-993. V0L.1JNT ftJ',V STRUC;T►,Jltifr .L IWODIFIi;Ai'100.9 VALt.�A'iICM 1+;�Uroo !.I3 Fb"T`IMA.l.`.PID C"oFf OF C-QNS't'RIIJi:`4': oll Yt);.sik� (IiD P)E.'.Ia] ,r",1 SUMMARY Ct.4N11f'i'jii.Ut 1,'f0'N Pyk 101.000.41.8-©06 5IX0 Si'PON 0 M 0 TJ 01-4 F9 • PZU1L) 101-000-241-000 FEB 33 2003 1 CITY OF LA CIUINTA ". FINANCE DEPT. SUB.-TOT'AI. I,t41M.UCTTON AMID M.AR C`z:ti?a'X _ V 27.05 1.1KISS FIRSrC.f9.1..1.J' i'.f.Rs +$0100 TWAY, }'7ICRMU I► NIU;1)ATIR NOW, RECEIPT DATE �� lr f BYL - FI LED INSIVI e �. OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms &Footings Ducts Slab Grade ReturnAir Steel: Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Frarning I Compressor Insulation Vents +� Fireplace P.L. — Grills Fireplace T.O. Fans &-Controls r Party Insulation Condensate Lines w Party Wall Firewall—��— Exterior Lath — ^� Drywal; - Int. Lath s RrW —i Fina! POf)LS - SPAS � BLOCKWALL APPROVALS Steel Set Backs _ Footings _ I Electric gond -i —Main 0,ain Bond Beam — Approval to Corer Equipment Location Underground Electric -- — - —--_•_-- Undergro>und Pfbg. Test - —� - al Gas Piping `--- PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping � � Heater Final Plumbing Final �t Y� — Plumbing Top Out�_ Equipment Enclosure Showa Pans -- ewer Lateral ( Sewer Connection+. -� O.K. for Finish Plaster Pool Cover _ Encapsulation ?j Gas Piping Gas Test Appliances, __�_---- Final `i COMMENTS: —� Final �_ _ i — /7/ GO //�O�liGi %/29��•� 1 Utflih, Nott^e (Gas) — ELECTRICAL APPROVALS Temp. Ppwer.Pole UndergroLnd Conduit --�-- -- - --� Rough Wiring Low Voltage Wiring Fixtures l Msin Service Sub Panels [ Exterior Receptacles p Joke Detectors— emp. Use of Power Final Utility Notice (Penn) A— —