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0206-186 (RER)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: f(e ) 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 Date e.�42 reason s Dat. 0Signature of Owner,. r����,,� 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. ( ) 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 Policy No. (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' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with t 0 proves ns. e Date: 67` gyp` f�°� Applicant's 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 harmles's 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 PERMIT# DATE VALUATIONma`o LOT TRACT /L7 JOB SITE -' ADDRESS !4.221 11MOAL MZXKR0AJCr APN OWNER • CONTRACTOR/DESIGNER/EN INEER 54.227 MAI CREM ROAD 3:,,rXQT NTA CA 922x3 CLIA USE OF PERMIT 1&WYWnAL RMA0D19, K1'E&IOR P'..k:S=g4TML #2EAA0090 P t APPR.CVED PLANS. RVILREMC DEL X000.00 LS COST OF C6.3LVST.iS.'0'w1TON Mi9wt sio •'�1y'v�FMAUD ��d'�SS.WA1 �Yi 1FiS:`I k�V.7 ulq.ii7dfRi4.:G PL.AX CHECK FE �Ol�ixO�►�:��•��� ���J�;��. CCJM3°`C UCTION FEZ , 101-00&418-000 ULEC•TRCa4L RE :' 101 a000-420.OW S40aib P..UMBI Q ter 9 ©2-tiflwi�t 1 -gGr4f - ; �g3.Ca STRONG MO'iION ME - WESID 101.0004AI•,000 rf 2 0 2001 LAQUINTA CE DEPT. s-TCi.A.t".. cC31�f^F1':f: "�ucmaw Am Pi Aw aw-C'F.t. $62 9.90 1830 II&E-P AID FEM $0.100 TMAL MINOT M5 DMI; NOW j RECEIPT DATE, BY �' y DATE FI `� IN O PEC `/ INSPECTION RECORD OPERATION I DATE I INSPECTOR OPERATION I DATE I 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 p { ( a 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 k POOLS - SPAS BLOCKWAL APPROVA a 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 Top Out _ Plumbing Final 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) i i i i Contino Residence Remodel 54-227 Shoal Creek La Quinta, CA 92253 1 j Approved Plan Set 6/24/02 I Owner/Builder and Inspector Notes: f 'V_ -Inspection required during demolition at Kitchen to verify that no shearor' Joad-bearing elements -are adversely affected by proposed wall removals., ✓ Verify that fireplace hearth is readily distinguishable from surrounding or adjacent floor. ✓ Verify 30" clear width space for installation of water closets at all remodeled bathrooms. ✓ Verify general illumination by high -efficacy lighting on separate switch at Kitchen. 1 ✓ Verify at least one high -efficacy light on a separate switch in Bath adjacent to Bedroom #1. ✓ Verify switched lighting outlet at Bedroom #1. ✓ Verify proper location of all smoke detectors. ✓ Verify GFI protection of outlet serving spa tub at Master Bath. t "AN ADEQUATELY SIZED DEBRIS CONTAINER IS REQUIRED ON THE JOB SITE DURING ALL PHASES OF CONSTRUCTION AND MUST BE EMPTIED AS NECESSARY FAILURE TO DO SO MAY CAUSE THE CITY TO HAVE THE CONTAINER DUMPED AT THE EXPENSE OF THE OWNER/ CONTRACTOR." , CONSTRUCTION FOURS October 1st - April 30 Monday - Friday: 7:00 a.m. to 5:30 p.m. Saturday: 8:00 a.m. to 5:00 P.M. Sunday: None Government Code Holidays: None May 1st - September .30th Monday - Friday: 6:00 a.m. to 7:00 p.m. Saturday: 8:00 a.m. to 5:00 p.m. Sunday: None Government Code Holidays: None A RE -INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED +' INSPECTION.,"''', NO EXCEPTIONS! CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVE® `FOR CONSTRUCTI N DATE y BY "AN ADEQUATELY SIZED DEBRIS CONTAINER IS REQUIRED ON THE JOB SITE DURING ALL PHASES OF CONSTRUCTION AND MUST BE EMPTIED AS NECESSARY FAILURE TO DO SO MAY CAUSE THE CITY TO HAVE THE CONTAINER DUMPED AT THE EXPENSE OF THE OWNER/ CONTRACTOR." , CONSTRUCTION FOURS October 1st - April 30 Monday - Friday: 7:00 a.m. to 5:30 p.m. Saturday: 8:00 a.m. to 5:00 P.M. Sunday: None Government Code Holidays: None May 1st - September .30th Monday - Friday: 6:00 a.m. to 7:00 p.m. Saturday: 8:00 a.m. to 5:00 p.m. Sunday: None Government Code Holidays: None A RE -INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED +' INSPECTION.,"''', NO EXCEPTIONS! CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVE® `FOR CONSTRUCTI N DATE y BY Feom, JV vV- ADJAC041 -FIT e� ;7, o � � P Io -40 ell 77 - i—� --- - 3 , 9 ,, �' ! Tu• -1 �aJ G �- cj - ��'� I��� ��' -w , I . L �►`l G-t�� I ` � ,� o I �-+s - — —offG1-tES7 �l of NICHE L- - I. To -H �o �rF. EXIST I �!<,j c,}.} I -l.r; I w/KN EE wA-41 - GD►.I D I TI ON C►� 4mo NDS p SI'� Ir XisTl �� ��'fH 2 _ 'IP s Cl//� ESI Irl N� --� _ �' LIENT No. wo�l� FO ? C0 ®� SEP I �� Qlr nISTRv CTS N -r.. c UT K -I M + ED S 1-t�L. � G � E� 1�. 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