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0201-153 (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 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: O I, as owner of the property, or my employees with wages as their sole v. -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 :node). ( ) I am exempt under Section B&P.C. for this reason Date Signature of Owner '-,.,,,WORKER'S COMPENSATION. DECLARATION =:r.- 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 STATE COPdf�L?)Sll7'1 Policy No. 046-0 900616$ (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 irVzany 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 provisions. Date: War ti�Applicant ��g.�secure w Workers' Compensation cov rage 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. fN.' 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. y 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 prope ffor inspection purposes. Signature (Owner/Agent)��� SUILDING PERMIT . PERMIT# DATE VALUATION LOT TRACT JOB SITE APN ADDRESS 80.599 W,t XISH DAY _ OWNER CONTRACTOR/DESIGNER/ENGINEER CCS X I GA�k S ti 1 U QPM (TOP 6ir M C10 2280 ` MDLOW ORMLEs SUMB 7 30 7 47 25 10'M :tYA VR,3� VXTUR 4A CGS OM& CA ;i -I PALM .DAMU C*A .92260 (760)734.0-9000 C N 00355 USE OF PERMIT V0001 ANDIOR SPA iF'00 SPAT, OAS STUB, SSQ (AW1 ZJI 18-105) AI.AR.144 RARJUNRO Pjr"tE 4, BE W PLAC E AT PR&PL,ABINk '�r,C�ifil.�'�4:�AdT 173Ffi'S.C��rli"�©7' l7dCi.Rt.�2�li. . P00bA. DOR SPA 11,ws w- ` POWEr Ste: 9U1lNWf RY PLAN CHECK = 101-000439-318 CONSI'i'RUC;TION 8%t . 101-000-418-000 i3 ^. . t�4WIl�`��-..t��01. �Ci1�00•�21�3U0 ��h.di� ZL ECTI 1Gi L V01T, a WX)11 1011-00"20 -000 t $45.00 t?IOUIABFl O'F1<:k:- POOL, •101.000 ,19.0010) $27,00 JAN ' 2 2 2002 CITYOjFLAOUI ST'.l'�`t�,�),.. �"C3�:~T ,;:. ',"- J�i�,7y./��,/5'] q'{���(t���('�:: g�tjy�{• -.4 RECEIPT DATE BY DATE FINALED INSPECTOR P. 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 OX 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 steel'- POOLS - SP BLOCKWALL APPROVALS 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 Sewer Connection Gas Piping Encapsulation Gas Test Appliances Final py 6G� COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm)