0206-073 (BLDG)hereby affirm under,,penaltyof perjury that - I- am, licensed under provisions of
IVV�7-" 'I Chapter 9 (commencing with.-Sicifoti'*7000),,*,of',Divislon 3 of the Business and,
IN Lu,_ Mbfesslonals Code, and my. Incense ld'In full force and effect-')
'
Ucense # Class— J Exp Date,i.
iN CY In
LU 7331353
1z,z ;-AD
0 5.
A
OWNER -BUILDER DECLARATION,, _-r'-
rrn under penalty. of ipedury that I am x
W herebi afh exempt from the Co'n'tractor's
LIcenie Law, for ihe;,Wlowlng� reason
:z 1, �is: ovine of the Orope*- or mj`employees with wages as -their sole -
compensation, Will do thevork, and the'
structure Is not Intended or offered for
..sale (Sec. 7044,'builnesd & Professionals Code).
4
I,,-as.ownebUthe *property,, am exclusively. contracting with licensed
contractors k.to"i I
6struct the. project (Sk?�'7044,� Busin.eiss Professionals
Code).`;ti
Cl) ! 1
ham'exempVun6r,Se66;h'B&P.C. for this reason
SIgAatUre,of , Owner
8.0Y
0- WORKER'S'CO PiNSAhON'-*DECLARAT'ION
z
0 2. hereby affirm 'unddr!pana'ltyjoi}pe'lUri'y+6ne of the following" declarations:
Ln <.
have and will maintain alcertificate of consent'to self -insure for workers'
X ILLi'LL -
J� compensation, as:provided bj'Section 13700 of Labor Code, . for the
0 -J -J iiforinan de of the work for which this permit is Issued,
M —1 �<,`
<10" I have and.*111 malntain,4
workers' compensation' Insurance, as required by
S on 3700 of,;helabor Code,' I for,.the performance'of the work for which this
< I
permit lsllssued.Myr workers compensation
cOmp'ensationi insurance carrier & policy no. are:
CaniIr4_1M10i4&0;C!Q.J- Policy No.
(This section need not be cornplit6d the `permit valuation 16 for $100.00 or less).
(•)'l certify that in'the performance of the work for which this permit Is Issued,
Il sh;ill 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' com
lientation.provisions of Section 3700 of the Labor
',Code, I shall forthwith comply with those provisions..
1co
ate:&Z-4--o .A
pplicant -
Wto :,Warning: Failurg secure -Workers': Compensation coverage Is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition t6the cost of compensation, damages.as provided for In Section 3706
b:, 'of the Labor Code,,intirest and attorney's fees.:,:
IMPORTANT Application;is t;iirebi mad6t0 the Dir'ect6rofBuilding and Safety f
conditions and for a, permit -subject ito, the - restrictions .. set forth . on his..*-
-,:r 1, i P 1
.'application - - 1 upon
. --,f
1. Each pers6h
6po'n wh6siI'behilf thIs'appikation is made each person at
44
{A'Whoso request and for whosdben6flt work is -perfoned under or pursuant to
pmany permit Issued1,a', Result
of this applicaton agrees to, &,shall,. Indemnity
&-hold harmless the City of.La ft Qulnta,tofficers, agents.and employees,
a0611cation becomes null and void If
14 2 AnypermlOss6ed'as a result `of this
.iworOs not d6mrnencedwIihI6J180 dlaysifrom Vate*of'Issuance of such
permit, or cessitl6n'of work for
`,180 diysJvill subject pe'imit to cancellation.
A certify that I lhh%6 read this -�appliciii�6thand ;4it3ta'te"that the above Information Is
correct. �l agree to comply with all 'City '6nd!State laws relating to the building, -
"Construction,'and hereby 'authorize" representatives of this'City to enter. upon
4
BUILDING, PERMIT
DATE VALUATION LOT %_TP
v- TA61
JOB SITE
ADDRESS B11*ATAHGLXW00D 5t
APN
OWNER •CONTRACTOR
IDESIGNER EN INFER
kvpok7Vi.Oi lul ='mllrwi, HomwwNm
w wmtmm mmn. , omt ,
SON MIOPMAM PL�.=
LAdA 92253
SAN DWO
.Q
(958)535.1475 CDL# .3Q23
USE OFPERMIT.
OMMAL BUnZING.
SEISMIC FIXTRO-FIT; HLOC). 4: 54-643,54-649,54-634
� _114.661,
VAWAilON Ls
MWATED COUr OF CONITf RUCTION
601000A)
PERMT NVE WhWARY
CONOTRUCT TOW PER 101-000-418-000 $459,30
STRONG MOTION WE. RESID 1011-000-241-000
AMB -TMA): IMM, f RUCTION AND KAN CHFICK
$465.50
LESS TIRE-PAMFMi
$0, 00
MMOT F DUE NOW
a
-0y Of LAQUINTA
r
FINANCE
f1ECEIPT I
DATE s.
INSPET/
JDATE _ALE 7
7
1 4
INSPECTION RECORD
OPERATION-, 7F
• DATE'
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING -APPROVALS
MECHANICAL APPROVALS
Set Backs
U Ducts
Forms & Foofinp
Ducts
Stab Grade
_
Return Air
Steel
Combustion Air
Roof Deck -
Exhaust Fans
O.K. to
FA.U.
Framing
cmvmsw
Inudation
Vents -
Fhpiwe P.L
Grills n
Fkepfwe,T.O.
Fans & Controls -
wan Insulation
-'Condensate Lines _
Wan Flrewd
Exterior Lath
-
DMid - Int. Lath
_
_
Final - _
Final -
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footinp
Main Drain
Bond Beam
Approval to Cover
Equipment Location - -
UndergmxW Electric
Underground PI . Test
Final
Gas Kip—ing
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water
Plumbing Final
Pkwtft Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Piaster
Sewer Lateral
Pod Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
-
- 1
;
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)
09/17/2002 01:04 7609227550;,; FARNSWORTH IORO
99/16/2982 13:06 7689227559 -
-- - - - -- F R-fH IORO
Verbal D iona*nd/Or InWUCtions whh Contractor/Ar,Chitect.
2
_.__PAGE _ 06 _
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09/29/2002 12:56 7609227550 FARNSWORTH IORO
VWtW Dlscusslons and/or Instructions with Contractor/Architect:
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09/30/2002 11:55 7609227550 FARNSWORTH IORO
Verbal Discussions and/or Instructions with Contractor/Architect:
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