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0105-248 (RR)n. 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 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: 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). O I am exempt under Section , B&P C. for this reason , Daw/,?f"Yr. P Signature of Owner ,v 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. (This section need not be completed if the permit valuation is for $100.00 or less). ,(gyp} 1 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 subje"ot to the workers compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply withfthb a provisions. , .--- Date r'' Applicant p � 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 Safe�tyt,.r­ for a permit subject to the conditions and restrictions set forth on his'.. application. ,w, ••- 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 cf 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 BUILDING PERMIT PERMIT# {_ c DAT.A E�;,, _ VALUATION LOT 0 1 0,5%_2 TRACT JOB SITE APN Y' ADDRESS n y�y ! av yyo r ,A, X%4,a [��BUi4 RO •. •, OWNER - CONTRACTOR / DESIGNEREN (NEER '.<rkTAr9T.�iL1A�"'1.:�.11't,V'.CC,� +/ 4J Y7Td.��'�^dJ ld YLe7J.Ca4� 53-745 AVEMDANAWARRO 'LA QW)WIM CA 92.25 1 r USE OF PERMIT CUM ,A. ONLY U201 OF j,t14G!a X111r1CI.IIA'9.8XD C08T MY 1ONRST. U(Mo n d ), qq gy.�gg pp/�� yy 7yy�q y�y p 3�ASiFtrim7.0,J1',� d1ap. �6J:9S'L17riS3dK� N.-EROOP AVE 101-000-430-000 DOM L n za 311 . t °tiY: crrfox A.tw r% AN O'E�E;S�,'eC ;9C�.t9;3 . G;1 U 1,1 3 k?�s-:f'l�i:�:4.7RI I AL VEMART 11110 -i's DUE, NOW MAY 2 1 2001 CITY OF LA OUINTA FINANCE DEPT BY DATE FINALED INSPECTOR M 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 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 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 S er Connection Encapsulation G4 Piping G s Test A liances 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.L, Smoke Detectors Temp. Use of Power <y Final Utility Notice (Perm) Building 2 / Address /P%1 -h L N pro /�r•4U� 2%� P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address City Zip LA Contractor Address City JZip State Lic. & Classif. Arch., Engr., Designer Address Tel.. City Lic. # Tel. 11LDING: TYPECONST: OCC. GRP P. Number Igal Description ._ oject Description Sq. Ft. No.- . No. Dw. Size Stories Units NewLEl' Add ❑ Alter .0 Repair ❑ Demolition ❑ CityZip Grading State Z ct Lic. # Driveway Eno, LICENSED CONTRACTOR'S DECLARATION I hereby affirm. that I am licensed 0-d. provPfons of apter 9 (commgnA�mg with Section 7000) of Division ¢the Business rofe siona Cd' e, and rt�y 7svrrfutlJo=- and effect. 0 (( r Date Owner Infrastructure SIGNATURE DATE OWN -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following Estimated Valuation reason: (Sec. 7031.5,Business and. Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish: or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement thathe is.licensed pursuant to PERMIT the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Plan Chk.. Dep. Plan Chk. Bal. Division 3 of the Bustand Professions Code, or thaf.he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ' I -J 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who Const. builds or improves thereon and who does such work himself or through his own employees,M2ch. provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of.proving that he did not build or improve for the purpose of sale.) Electrical - Ll I, as' owner of the property, am exclusively contracting with licensed contractors to con- Plumbing struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for with f f d t t theContractor's License Law ) S.M.I. A AMOUNT such protects wit a con ractor, s) icense pursuan o Grading ) I am exempt under Sec.—B. & P.C. for this reason Driveway Eno, t. �.- Date Owner Infrastructure WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company rJ Copy is filed with the city. O Certified copy is hereby furnished. TOTAL CERTIFICATE OF EXEMPTION FROM REMARKS WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation - 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 as orlo become subject to the Wrst-Compensation Jso LawDates ofCa�or 1'ner ! ` ` 14 (^ 43� K .- NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become ZONE: BY: subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances: comply with such provisions or this permit shall be deemed revoked. Front Setback from Center Line Rear Setback fro -n Rear Prop. Line CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line ' I hereby affirm that there is a construction lending agency for the performance of. the - work for which this permit is issued. (Sec. 3097, Civil Code.) - Side Setback froin Property Line Lender's Name Lender's Address FINAL DATE INSPECTOR This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. Issued by: Date Permit- I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives sof this city to enter the above-. mentioned property for inspection purposes. Validated by: Signature of applicant Date Mailing.Address Validation: City, State, Zip BUILDING DIVISION CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. @ $ 2ND FL. SO. FT, @ POR. SQ. FT. @ GAR. SQ, FT, @ CAR P. I SQ, FT. WALL SO. FT. @ SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as property lax valuation BONDING FLOOR DRAIN MECHANICAL FEES FORMS s' WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GAS (ROUGH) GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED OTHER APP./EQUIP. LAUNDRY TRAY AIR HANDLING UNIT CFM TEMP. POLE KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. ra) c BATH TUB SQ. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11A c SEWAGE DISPOSAL SO.FT.GAR 0 >/ac HOUSE SEWER REMARKS: VENTILATION GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING R AIR COND. SOLAR SETBACK '68OUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE /' ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS s' SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. , / GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM i/ 9 ((( ATER SYSTEM GRADING cu. yd. $ plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION , L . e CERT. OCC. FENCE FINAL IUN"J 51UNA I UNtA-llN I t IALJ GARDEN WALL FINAL