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9901-014 (RPL)�' LICENSED CONTRACTOR DECLARATION Y I'ereby 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 Profes"sionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date F3�i:)U1i� l9 iA/?t?l tlti Date !!2 Oa.. Signature of Contractor 7• 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. ( ) 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. STAT11 FM11 (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 those provisionst Date: _ ^ + Applicant— Warning: pplicant Warning: Failure to secure Workers' JCompensation 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 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. /f i Signature (Owner/Agent) `{�'' � • z2 • ► Date)) _� �� ..�� C� t � PERMIT # BUILDING PERMIT 9901-014 DATE VALUATION 12.009.011 LOT al TRACT t _.<q ADDRE S J 70-2901 TO./dr�3NJ APN - - OWNER CONTRACTOR // DESIGNER /ENGINEER EwyraVCuc gtrr V:3IENNLIS, A9CIPU y 1'0 BOX" 810 11'251:, iiNIV"k.18Si"I Y DRWE UA. Ql,di'[ VA. CA. St2 Y3 P1 08NIX AI 851134 (602)257-1656.• CRL# 4996.1 USE OF PERMIT POOL ANDiOR SPA .PO01;J81AA, ALMtMW8ARRffiRS Sl3dCL.HE Iii AT PRE. -PLASM -It FOOL ANDIOR SPA 1 63a:ii�'1 S ESTINLIXED COYT Of CONSTRUCTION PLAN Oii.t� y'K FEE 3(11-000-434.318 srl3s !:ONSTA.1,1M.-OtFFE t(! 4KI 1-418A00 $135." MECINTANICAL = — POOL 1014G'O-121-000 $24.00 ELEC'MICAL FF..E --PO©1 101-000420-000 645.00 P;LI.)M13M FEE, -- F'U+A, 101-0004i9V00 $27,W Si,. tom. -'I'1`ffAI, f`,ONfSl'T .UC"'f (ON ANI)t+✓�'.lC.LAN t4ECIIZ,. 31�R.A�DS CpFE C S PP p `:TOTAL li°Z1<2Mrf F4+ ES 000. Fj'le NOW �;3l,fi.7S 5� 4 EIPT DATE BY DATE FINALED r INSPECTOR 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 POOLS - SPAS BLOCKWALL APPROVALS Steel 1 11 Set Backs Electric Bond 21-1 Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI . 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 Encapsulation - Gas Piping Gas Test Appliances Final _ Z 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)