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0209-035 (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 6.56128 C53 File 093. 1 0m, 1102 Date `f�- Signature of Contractor A��'% OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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). ( ) I am exempt under Section B&P.C. 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. (. f , I have and will maintain workers' compensation insurance, as required by S ion 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 1 TATE CORal1'ENRATI Policy No. 0460906160.01 (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 subject to the workers' compensationprovisions of Section 3700 of the Labor, Code, I shall forthwith comply with biose provisions. ,,,,Date: 42 /2 17 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 andvoid 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��purpoosq . Signature (Owner/Agent) '' g'` A,Ll Date -7, •- BUILDING PERMIT. PERMIT# 0200-0.1 DATE VALUATION LOT TRACT JOB SIT I E ADDRESS^ $4 �?. § �0 APN w OWNER CONTRACTOR //`D�EyS�IIGGNpE EtNf �y meq / qq��yy��gqf�Aq��`y'y{ 1y q�p 717,0W d"F7�k.�Ji6OOK J...�EW.J:oi.�OPMZ-4 '717,0 .64 13d.'� J.. tR�/ `1NyE,9ERp �� crap � � �p +�r� Y.J.P�1,SY�l.11K1Vl2F X)OW.I...si:' C?F+ SPAS C4 NI ,Ltl�.A tr�.d .1�€t?,ta,��-�i A.T-24ONAB �i6-1�U�iq�yA+�iyFrNIJT; 54 <,q/q/� F.rX1S5.d..iY AD S. A 92008 p y�y Iw4!I!•f.e.l�.Cri IA " . � C.A 92.2 J'6 (76V)-.49 ,92.21 .,t:,' Clud,4 C60.455 USE OF PERMIT PMUSPA.; AL.A?:M4MARRIERS SHALL HE 1�24 PpIqACE AT KroVI,,-ASTER ' AAS i�eT�Ei,l �e��f��/4r:.�'. �r ��.� tY_S'ALrt.@'l.1rd�lS'.I.CZIa idM'bi4.L 4 FT, 'GALL POOL AND/OR, SPAi T; 3fi!).>M I's EREV"YED COST OF CON"MUC:T'ION PUN CHWX nX 101-000A.310-318 A•3104318. %122.81 CONSTIif:3 1110I+,P'EE V89,00 M&CHAAICIM, FEE __ POOL 101-,000421,000 $24.00 EUCT ICAl, FEE — POOL;; $03-�3i3a-4�(!»t!{Dt) $45.00 PLUA/1BINO FEE -- POOL, i ICt1' dRnl.9-000 SEP I 1t'i[Q -lrlryo LAQUINTA FINANCE DEPT. A Yc' e ', v^ . ?*Il'TaT 'fW'YII . AND �'a;.14 Z.JIM111K IX#,.%S PRE -PAID FESS $0,00 m RECEIPT DATE BYD ALED I P TOR 7-e r�- % J. J. t ,1.1 �4'' lul. 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 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 BLOCKWALL APPROVALS Set Backs _Electric Steel Bond POOLS - SPAS Footings 44MAOI2 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 J 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) COMMENTS: 0 ------------.r — — — — — — — --- wr ----------------- J JJ0R1'lA)N CO,Nl L':) FRUC TI P-sT A' L., k -I ----------r__-------_-_— ---------{i----- IS A _I -S — — — — — - 171EI-13 DfG — — — — — ---- — — — — — — — — — — — — — — — — — — p I Z I--- - G t 'N [TE — — — — — ----- — — — — — — — — — — — — — — — — — — — — — — — UNDERGROUND I --------- � — — — — — — — — — -- — — — — — — -------- 1A A A RY i ! — — — — — — — — — — — -- S"E D E CK ----------- PRE -III --: 133 I - I — ----------- — OA -- — — — — — — — — — — — --— — — — — — — — — — — — — — — — — — ----------- — — — — — -------'— — — — — — — --------- — — — — — -------- — — — — — — — — — — — — — — — — — — 5"E C I F 1,-'lAV ONr- — — — — — TYM NAF AO! AJtF_A ow Pool 4 S"E ?014, — — — — — — — ----- -- — — — — — — — — — — — — — — — -E — V '1� TILE "T_ LLJ lr,k CAM VLALJ. " 7TI4 KAT15q J.IW m. 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Saj!e,-r Toov,;eorAh:�e 2F (3) VeT 1XI$* "t<MV- SELL AT LEAST TYTI-E VAJ-y " SpaN DAYS ^o-rR 50t_L 15 jI,$TALav .1 .6 Zvo (4) AeRM! TO -AT ALtlI;OXNlA FrVL5 I-- NOT W tV :OVITIORS 0-t CO-ISITS AX7 ANI'le 2A►"! Tc) GITeq,,5 MqAL<S, MVEYWei, L4VS, CR CMtlt fl!M) is TR! N:ce5S,vmA, 17) tL-! TiAT ALL PEIZINS, isAT!S, AW) &,MASe ;OC)" W, PRIOR TO PM"r!R N�iois t EWSLOSLOM c� (6) FILL P=. R4-l!!--lAT!LY APrZq RLMITIR. (FO -LCA jt5TFVC-Jotj5 - C)C? W V5e ma" How (T) TACE 140rCZ TROT r4t5mm/ f6 rs TIIr Sxf jFR:),njtr, cw, CALFIORYA PO%! AN7'r:4AT Attr W,1 rINCUIT Csp CALjO%NpL pCOL!, N_ I!, p1toH,5'71m Oy jAH 01*Vt An!'WOVI!5 FLN� POOL MO EWIIWIT LjL#-"kTk*e AW w\5 FV -AL2 r$ fZl5#"5151-M!5 qV NonCm Aaall, ----------------- --------------- — --- — — — — — — — — — -- Slc;kA rLJR 5(5) 1WTE -------------------------------- -- 7 — — — ----- 5KYMING POOL FLAN FOCZ: C") t1OHR) NSON & KINGExj-r RESIDENCE_- S TR EE'r JOB ADDRESS CITY OFFICE EF!ONE SES LOT -'r ( TRACT i7A 3E MAP BOOK PAGE N0.__ — — — — — — — — — — — C T) -- — — — — — — — MAIL i�D)RESS CONSTRUCTION 0:'FtC[- iF�-6-11TE--N0. —— — — — — — — — — — — — — — — — — SC7—tEDATE -JRAWN, EY I SOLD 13?,27 CHECKEC ElY //8, g-z-�,� 1 ef 0 C Q� R E \/I -S) D 4TE �_-__ - - - - - - - - - - - - - - - - - ---- - - - - - - - - - - --- - - - - - - - - - - - - - 2 — -- ----------- 00 ------------- 3 ---------- ID C T E_L`� o� ______________________ S-701NE -------------------------- — Ti -E---- V� - CH k ------------------------------- BOULDEPS --- ----------------------------- DECK - CLOR Q %j a --- --------------- - JIADY w r"f-"J) 11IN t c, L, r rl — — — — — — — — — — — — — S1,3NA-V�E DRA NAGE NOT[- Drcinag,� c -d irric�jc:icn for planters and pots, by others, unless othemisa roted. 1-7717-777-1 j1J. -ILL