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0206-106 (RPL)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 6.128 C33 IAC' a , 0/3 1/2£ 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). 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&RC. 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 40MYS COMPERSAAT) Policy No. 0465006168.01 (This section need not be completed if the permit valuation is for $100.00 or less). 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 of the Labor Code, I hall fort with comply with'thoselprovlslons. //d� Date: : Applicant -7., ,� . J; ;rs .o �:'d:.`.-.a y Warning: Failure to secure Workers' Com pensation 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 ori 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 pursuantto any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City,of La. Quinta, its officers, agents and employee D 2, Any permit issued as a result of this application becomes null and void work is not commenced within 180 days from date of issuance of su permit, or cessation of work for 180 days will subject permit to cancellatio I certify that I have read this application and state that the above information correct. I agree to comply with all City, and State laws relating to the buildin construction, and hereby authorize representatives of this City to enter upo the above-mentioned property fo inspect' purpose r Signature yr a +�i srs 1/1 ' 9 (Owner/Agent). Date „ PERMIT# UILDING PERMIT, r DATE VALUATION LOT TRACTJOB SITE ADDRESS : +`�:4�i� Ii:d7ii�ly APN + OWNER. '—, _- CONTRACTOR/DESIGNER/ENGINEER CEWKX,NONEa" , GAL.WOMA,P0019 A R.PAS.C1CylMM, CO 2250 WATRDWW1CtIA, SUVE 130 747 ,i0NT DIM, NUM?, #A C°ORUNA ,;.'CA 91720 PAUA1;,#Y.S`-Wr CA 1,2,260 ��4�,3�d0a�Otlt1 C1��:• ��t3;.,�5 USE OF PERMIT POOL AMOR 31PA POPI, SPA, Cif- AND EL,W,,TIUC L,:Aid.y"i FOR FUTURE DEQ (ANSI Z�21-58.1900), ,A.LAR OMARIUPPV SIIALL, lif.IN PL ACP AT �; ., PRE-FI.,ASTER INSPECTION. F.,QUII'Lbl'' N`1'• ZAICLOSURk NO�IYdCLLIX}�D. ' 1 .. M VALUATIOA1 1 ,SdID.ttO 4:J' Y, EMMM, A' con 01? Co flumum n 1815W.00 PLAN CREC K .ME 101-000-439-318 % �1A.70 rk S7'�L?C°I` rJ I��3 C% --t2£1 `�L 3"i8 i rS8, 00 ME CHANICAL VES ' .POOL 101-100.421.000. ETr'C'IAIL FU.es POO 3.. 1(?1-0tiflf.?..0-titfifl3S.Du 1'I:McItvlOTHO FF2 -• POOL, 101.000.419.00£1 $Z1.0 • f trC)NSTiMt'° i9':OW AND TIT -W CIff-ICK M422.10 © TO'T'AL FIMW FEES DXW. RCM 9i4 e°� 70 JU.fiN 1 '� ZOUI ��CffYF LAQUIH A DATE 1 (i' BY JF ED SPECTOR R.1i INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE TINSPECTOR 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 BLOCKIMALL APPROVALS steel L Set Backs Electric Bond _ ' ` Footings Main Drain Bond Beam Approval to Cover Equipment Location Final PLUMBING APPROVALS Underground Electric Underground Pibg. Test Gas Piping Gas Test 7� 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 ZZ Gas Test i Q— 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)