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0102-011 (RPL)z.� SO- LICENSED CONTRACTOR DECLARATION Thereby 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. Cla§s Expr-Date, .: 5741217 A C6.753 t� pate ��� Signature of Contractor„td'0P,=��'✓�y�P ,� `! 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 \ ( ) 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. Se(� f I have and will maintain workers' compensation insurance, as required by ction 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: Canner 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, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and ag"iee tha i l speuld become subject to the workers' compensation provisions of Section 750 of the Labor Code, I shall forthwith comply with th sr visions^„ . Date: Applicant tr'"y`�' `.✓°i`.<� ..'...� ••i, Warning:failure to secure Workers' Compensationscoverage 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. w 1. Each person upon whose behalf this application is made & each lee&& 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,iindemnify & 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�,ofe'this City to enter upon the above-mentioned property for iins�p�e°ctioonn purp�. Signature (Owner/Agent) �r ' `z "K i Date.X �W j BUILDING PERMIT PERM T# DATE VALUATION LOT .©?i C�f.7E TRACT JOB SITE APN ADDRESS yr �y q� 43 t 2,,5 F.q :'A�6N.ffUS Ct..rMT .. ' OWNER _ ,. _ _ _ , .- , CONTRACTOR / DESIGNER / EN (NEER STARLIGHT)CCC., 1"... 4 STEVE DCT stet C4' YMII'RU 01 9c, 1 3.5 0. D g'METE;C 0200 7 011 C OUNIMY CLUB M, SCFME IT4 SAN BAFSNArdVZO) CA 92408 I)ALM DESERT CA 92260 (7603A64032 MA IM4, USE OF PERMIT ;6x<1t?IrANDf OR SPA, I•�ai,:L, r5: aI?i� Citd1 �l'•.tSZ.�3�.t+f1:�dI�A�',3�.,#3a+ �'!i��7..�.I�� t�� ��1,r�,C�f#'C . PURA:3T>E,P i"R;%PECTION.PtNX R,0UJPKffNT E?'6CI.f~'i IME IQ NOT 114CWDi'KT,'.+ 1M THIS PERMIT. PO;. L ,04DIOI? SPA 24,9400 LS i ISM7?!},AM COGr OF C 01519M%;iC"I"f:ON :$4040RD .PN '1t' FKC 43'FtMM&RY MAN 4;"rlEACK Fal 101-000-4 39.2318 MUD C00"STRUCP.ION PT8 101-000-418-000 SZS�.t3(I V0,!,)1, 101,,000.421-000 $24.0* tit','FW;�?Iv,AL IFF :Iv .Am l cn-CiC 04-2Gi••r.)w #TL�.bll'��'3 I��i� -• I�f;7lai.� 1 t�3 ,,,?1�R�419.OIiif 4�`7,9f) ` �' �; :IF;i2%-I'C1`tln . `+�1.i>3T1 .�C '1't33!d AND 'a1P1i.E�3�(3 . }��C[:ZIq%�pC�Z^:� / ES ,Iia'°1"Al«, "MMUT 1+.Ii`ES ,DITE NOW n 4, RECEIPT DATEBYE hry DATE FINALED INSPECTOR f, „J 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 r Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framina Compressor Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lin( Party Wall Firewall Exterior Lath s Drywall - Int. Lath Final r"'"'I IPOOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam ADDroval to Cover Final COMMENTS: Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Kougn vvinng Low Voltage Wiring Fixtures Main Service t Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final I Water Piping Plumbing Final I Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas PlDino Glflc1tJ Final COMMENTS: Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Kougn vvinng Low Voltage Wiring Fixtures Main Service t Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice