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0303-165 (PLBG)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 613326 C36 t3'iC 101-1.4 1 Mw 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). Yt_ I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). 1t �� O I,am..ezempt and r Section B&P.0-) this rea on t� �. ,D tae i< i �� Signature of Owner=wi `I 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 .EXEMPT 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, anAagree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,.l-s II forthwith comply with those Drovtsiotnsa Bate: j i '--2 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-mentioned property for inspection purposes: t � ---- ';In lis Signature (Owne^r/Agent) Date .6UILDING PERMIT PERMIT 0303-166 DATE ',�+%1 7n�c VALUATION $41SW�00 . LOT TRACT JOB SITE SS '77- 138 CALM CIMX N APNADDR_ w OWNER CONTRACTOR / DESIGNER / EN (NEER 1r11.,1=Y L7�: RUNi'RNY'S 1: LU.ty BDIC+ 13't� ,MUDA CIUNn CA 532201 (76(3}772.7953 CBLO 3925 USE OF PERMIT 3?I.UWSiNQ VALUATION 4,500.00 L3 ESTIMATED CGHT M C:ONb:1 ..1JC:7'T0PT P1<` MIT)iNG FEE - C T fd :1411.000.419.000 33U,v© U � 2aa3 l� LIAR 1'� CITY A - i ,DESS 37- d1sµk'�nil 1:.E.t;? Tam, t; .l:4dT+.7Y.(.eA Ym'.7 -'S-aF" n `Itw 44W.I.00 $30.00 $0,00 1:.40.00 lL RECEIPT DAA , , r BY �� �� DAT FINALED INSPECT 1 - /oZ �/ 03 A0�— 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 BLOCKWALL APPROVALS POOLS - SPAS 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 I ;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 I Appliances Final I Final Utility Notice (Gas) _ ELECTRICAL �APPROVALS Temp. Power Pole v 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) COMMENTS: f - i '� A-1 Cesspool'Service, Inc. P.O. Bog 580188, North Palm Springs, CA 92258 JOB INVOICE `Since 1959' (760) 329-6875 Fax (760) 251-3405 State Lie. #265214 Customer Order No. Date Ordered www.alcesspool.com I Order Taken By Date Promised ADDRESS CITY SERVICE ❑ PUMP SEPTIC TANK HAS SEPTIC TANK BEEN DUG UP? ❑ Yes ❑ No ❑ PMT. ON SITE REQUESTED ❑ PUMP SEEPAGE PIT AT ITS RISER ❑ OFFICE BILLING QUANT. DESCRIPTION OF PRICE AMOUNT 1 o00 Pumping Fee per 1000 Gallons (or fraction) Waste Discharge Fee per 1000 Gallons Locating and Opening Fee (I hr. Min.) Out of Area Fee ��t /1 r•�� i IL r1a ❑ THE LEACHING SYSTEiN HAS FAILED. ❑ THERE IS AN OBSTRUCTION "UPSTREAM" OF THE SEPTIC TANK It will he necessary to contact a line cleating company. WE RECOMMEND MAINTENANCE PUMPING OF THE SEPTIC TANK EVERY YEAR ❑ OTHER YEAR ❑ 2-3 YEARS To remove built up solids. This will increase the life of your leaching system. ❑ THIS PUMPING WILL PROVIDE ONLY TEMPORARY RELIEF AND NOT SOLVE CUSTOMERS SEPTIC PROBLEM BECAUSE OF THE ABOVE. ❑ CUSTOMER HAS BEEN GIVEN AN "EXPLAINATION" PACKET. A SERVICE CHARGE OF $22 WILL BE DUE ON ALL RETRUNED CHECKS. A FINANCE CHARGE OF 1 1f2% PER MONTH, 18% PER YEAR, WILL BE i CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. IF PAYMENT 1S BY CHECK DRIVERS LIC p STATE 1 hereby acknowledge the satisfactory completion of the above described work: SIGNATURE Total Dae 4