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9910-039 (RPL)LICENSED CONTRACTOR DECLARATION 1 hereb} 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 ` •1�$3 C -53 it 28i.2(it r-•, C jP Date jSignature of Contractor f¢ J 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 Datd 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. • (T) 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. STATE, 'FUND =,301'25-99 (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, hshal) forthwith comply with those provisions. �r•`!' �' e l Applicant - C ^ % f r 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,l have read this application and state that the above information is correctyl agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon theiabove-mentioned property for inspection purposes. 4Signature (Owner/Agent) /� . ~ ; Date fC' BUILDING PERMIT PERM T# 9910-0.41.9 DATE iown"VALUATION a1wgwwon LOT 46 TRACT 27729 JOB SITE ADDRESS 9t-.525 T6JWF PfIeeR9J' LANE NORTH APN ��iR••.�i'.liS••Q�i'f OWNER t CONTRACTOR/DESIGNER/ENGINEER CORDON & DOLt RES WP:.:rNf: :411RAGE NWAITK' FEATURES 801 S lkCACIA a ]T, 750$0 5"1'. CHARLES PL, #i3 CA 92931. 1'A1,d+'!G DUw.1i1 T CA. 9221.1 B7t 433 r 6}gK2 C AT.# 571 USE OF PERMIT PL -pj/Ok y l� POOL & S-jg ..,D VLY - AI.!\4.r1SW1.iAJ.kR L�'-kS SILNLL rii5 .N PL A'C E AT 0 F00�t•+� L V,W.,M SPA W,ii 0,0;1 LS ' 8'.�69.11�.`4•��li 4,�,i/.9.R•'�ri��7 t+f1.MiL�Il �i�h..CY�IV ��1�.7V:1`�.� PE.R 'T FEE SUMMARY PLAN i;t•WXX FEE 101.-00-439-3.18 CO NvTMICITI(`N FEW, 1(74 d)fl!7-rti�i fli7() �ti�.S�1 �1�.C'l�'t.1^7�C;A1. t�'k"sCs �- g�:ti'L 1itY-ff4�}�21-6)1)6) �1:6ity ELECTRICAL 1f�.13.-- F'WL01, 1(} 41f7-01XI $45.00 PL11MRItNO 1r&'...,1"3L. 101-0,10-4.1W4?W $27.00 u M SWIVYi'Al • C:'ONS`1"fd.Ul- SON AW) PLAN t;i-!1'C,`.tti, LESS :1`RE-I`AM FEES V4.00 } Ill."O A11. iH ReLOT FEMS, >t 1JENOWf /� f•� � . } ;'fit r f1) RECEIPT ' BATE "'` BY /' y / DATE FINALED INSPECTOR ,4 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 POOLS - SPAS Steel Set Hacks Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric /W,Afo_ Ungergauqd Plbg. Test / p Final a0iping PLUMBING APPROVALS Gas Test mal Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX for Finish Plaster Sewer Lateral. Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL. APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdues Main Se Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: of i Awk �G�{,g/.t/ / /" wiAew � � A.4 —11&e4 av /0- 4'.,11121,0V01Af /J i � ,' ,.c ...I !/� � Q •--//I I i ' ! _BY_ f P .DATE --- -JOB P�D►C�PI 1-- -73.661-Highway-11-1-!*_Suite G_.---._:_.. _CKD!--- DATE----- - __ A415Z5 foci F/� 'IU N. _ .PG,�_I -- i Palm Desert, California 92260 ' i - -- -(760)•779-0405---*—FAX(760)779-1317—�--• -�.— �.—_.�___�� __ .V%c-�UIOF L--- PREPARED FOR: ZT- Acl6 ! '-P_{�ii'z_-Co._Ns'(RJciTloN_�_ ���,- a�� -Poo L._ t -J ! ,C"bJ- -- ! --- N Uo_US I C --- !--- �— - ( --( --- ---iTT — -- -' - — — — i- - --7i I L— -- 'ST VE w �?_ N1 334461 - -- lao t� (1"� . ! _ 1 0F-- _. � I�!►1 ! � ILII! ' -1- - 12/05/99 2:47 FX 7603 1 0 _ Z02 ZAP 2 I ' • s '•'` /f r Of .... .. �StiJI riC�•`_f.'�?QL�� >. Fri �\�J '�:� •1 , ,i r.''P© A: HS YARD..'I •� .�•� � •" 6 G F r . �-��.. ' � ' tet, / • 1, .�..�:.�' _ '- �•-`. `�' tv . SUITE .�,,� '- . '• ' • j �.,;'� �: :'.,•; � ', ,� �' . ' ,. , . .,� `; : . , .. 116 . FL. 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