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0108-297 (RPL)4 }' LICENSED CONTRACTOR A I hereby'affirm'under penalty of perjury that I Chapter 9 (commencing with; Section 7000) o' ;.Professionals Code, and my License is in full fc ' 'License # Lic. Clas: �Datee1-C "" Signature of Contractor— OWNER -BUILDER DEC I hereby affirm under penalty of perjury that I e License Law for the following reason: ( ) I, as owner of the property, or my empl compensation, will do the work, and the structs sale (Sec. 7044, Business & Professionals Co( ( , ) I, as owner of the property, am exclut contractors to construct the project (Sec. 71 Code). ( ) I am exempt under Section B&I Date Signature of Owner WORKER'S COMPENSATION, I hereby affirm under penalty of perjury one ( ) I have and will maintain a certificate of cc compensation, as provided for by Section 37 performance of the work for which this permit is k )_ I have and will maintain workers' corripen See~tfbn 3700 of the Labor Code, for the I f'�.!$:E�ta�' perform permit is issued. My workers' compensation in Carrier Policy N (This section need not be completed if the permit () I certify that 'in the performance of the wor I shall not employ any person in any manner workers' compensation laws of California, and subject to the workers' compensation provision Code, I shall forthwith comply with those pro• isi 04- _ Date: 10 Applicant Warning: Failure to secure Workers' Compen shall subject an employer to criminal penalties addition to the cost of compensation, damages of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the for .a permit subject to the conditions and application. 1. Each person upon whose behalf this appli whose request and for whose benefit work is a'ny permit issued as a result of this applicat *& hold harmless the City of La Quinta, its o 2. Any permit . issued -as a result of this appli work is not commenced within 180 days f permit, or cessation of work for 180 days wil I certify that I have read this application and st correct. I agree to comply with all City, and St construction, and hereby authorize representa the.above- mentioned property.for inpection pu Signature (Owner/Agent) / 1 JCIrLAI'IAIIUN Im licensed under, provisions of ins sation and on ate - PERMIT# �. '• " I N G -PERMIT Division 3 of the Business and .,., ..J DATE v.", T; N LOT of i9 f TRACT rce and effect. Exp. Date JOB SITE ADDRESS AP N t j pKj� OWNER CONTRACTOR / DESIGNER /ENGINEER ' .ARATION CERT-0Y.,-0Y.,k};4aTt+g :° 1 �.�JOOIA & WAS CVJd' MAN (201 m exempt from the Contractor's "'26o WAWDLO,� max, 44'U 1.50 74725 3QM ;(,1R1VH% �Z # �A - Ce��.RC�NA CA S1.720 I, ?DEMIMT CA 92260 )yees with wages as their sole ?(76CT.440.9000 MIR 355 ire is not intended or offered for e). USE OF PERMIT ively contracting with licensed 144, Business & Professionals .�` 011,&' fO�:,ZPA.b, �7�? SPA, AJ.AJii�SiC�.�;RRIP•,� SHAH J., Jig I ;p;,,,{�C;Y. AT PRF,.-�'f.., S n'Lfi '.C. for this reason !•NOPFCTION, POOL d�,l}��€ISI+ WT IM'?riti �) URZ NtNOTINC'31SJM, DECLARATION of the following declarations: nsent to self -insure for workers' POm,1t,'�3��.($ ap..A IZ$00.©0 149 00 of the Labor Code, for the „ issued. sation insurance, as required by ance of the work for which this _ carrier & policy no. are: o. valuation is for $100.00 or less). 'PF'` W�{� � MAARY k for which this permit is issued, PLAN CHR KE 3 01 "4k00-4:���":� 1 R so as to become subject to the O{Y'4d .PLUC' ION ISR 3Cl_t••Cb0-d19-i1w agree that if I should become -F" MKOHA g{;¢ L, FES . POOL 101 -'00.421 -OW. $24-00.$24-00.s of Section 3700 of the Labor JBt-M"g Rici J trim.. P061s 101-000-42.0-0000 I �R5•Ufi ons.10 �`IsYJ�tL�i to Fu --� Pool, 1 X13 moi::L 419.ORC3 42M overage is unlawful and ". civil fines up to $100,00'0, in as provided for in Section 3706 Director of Building and S restrictions set forth o i =02001cation is made & each pers nITYpertorrried under or pursu nt t=IT C!'OMMI:3'�``I`<O�•,�:tsx? PLA19 ( Cl agrees to, &shall, Inde nify FAL OF LA QUINTA FINANCE DEPT. �'`''�' �'35•wQz aED F fficers, agents and emplo .'• "; cation becomes null and void if rom date of issuance cf such d�C��.:�1LF.KJ. �,,}.� 9D'ENOW I subject permit to cancellation. that the above information is ate laws relating to the building ' tives of this City to enter upon ; :. 4. rposes. Date RECEIPT DATE At BY DAT I PECTOR P . W, r ': • ► r N *0161 ', 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 BLOCKMIALL APPROVALS Steel Set Backs Electric Bond ���1 Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping _ PLUMBING APPROVALS Gas Test �0. Electric Final paste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Z. ower 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)