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9604-071 (PAT)LICENSED CONTRACTOR DECLARATION C0; -1 hereby affirm under penalty of perjury that I am licensed under provisions of ChapFer 9 (commencing with Section 7000) of Division 3 of the Business and (V W Professionals Code, and my License is in full force and effect. O Z) Ch License # Lic. Class Exp. Date � C) S'�l3T�12 SSV i 3S31f9Y W ZO r Date Signature of Contractor U °) OWNER -BUILDER DECLARATION WW I hereby affirm under penalty of perjury that I am exempt from the Contractor's Cn License Law for the following reason: Z_ ( ) 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). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). co () I am exempt under Section , B&P.C. for this reason L N Date Signature of Owner ON 0) Q ,i WORKER'S COMPENSATION DECLARATION C) 2 Z I hereby affirm under penalty of perjury one of the following declarations: p () 1 have and will maintain a certificate of consent to self -insure for workers' X W compensation, as provided for by Section 3700 of the Labor Code, .for the O J Q performance of the work for which this permit is issued. ED Q C) ( ) I have and will maintain workers' compensation insurance, as required by OU Q Section 3700�'ofltne(LabortC6d`e;tfor the performance of the work for which this Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are: ,It Z Cartier Policy No. w� r Q J (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, and agree that if I should become 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant 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. Signature (Owner/Agent) Date BUILDING PERMIT DATE 411'M)6 VALUATION S2. Z34.4.0 LOT JOB SITE ADDRESS OWNER KAY & 1l'ENJ SAaC.f"4CFt tiJ 786480 SONESTA int rp t LA QUINTA CA 2253 USE OF PERMIT m,no PERMIT #CONTROL# !�fs11.111, 3128 TRACT APN CONTRACTOR //qqDESIGNER rr /�E,N�GIINEE9Rr� y t t y 4.582:3 t' H WA sLOV PALM LANE I1+iDR) LA 92201 (619)775•,5249 C13L# 37.121 V, STINIXUD COST OF CONSTRUCTION l'ERMIT tH'EE NUAIMARY CONSTRUCTION FER 101.4)00.418 -MO $54.00 ULAN CHECK MEK 101-©64-439-318 535.10 31` )W41 moC r'(ON FM - RG'3ib 10.1 -WO -241.000 3.50 .. LESS PRE-RAWFEES ItY I Ali VV R,I1$f A F'�%.� Ut;V., iINt)W D ' APR 1 1996 j -.-DATE- BY DATE FINALED Z,234.40 S84.61t 0,00 S".60 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 BLOCKWALL PP OVALS 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 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) f 15 T° 1 LA QUINTA ll - IT i •, �r x,'� ' �.. •`-. rl,w c� !kms- %-;i•«^ LJ i �.0- NTr.'"',i_L%t ATO AS PER N AND ALL APPBCCABLE'CODES��� ^ DATE�l BY A.4 I V VLA - •. N 4. 1/ _ ti a J x N _v V U O a