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0303-014 (MISC)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury,,that I,p, . 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 I I - 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 isnot intended or offered for sale (Sec. 7044, Business& Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed yontractors to construct the project (Sec. 7044, Business & Professionals Code). _, h (.) la exe pt under Section B&P.C4or this reason Date ,� • � Signature of Owner Jt . WORKER'S COMPENSATION DECLARAIrION 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: Cartier 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 tshall 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� pPro isions of Section 3700 of the Labor Code; I shalljforthwith comply with t 6se p ovisions. Date: J -02, Applicani i ✓j" - Warning: Failure to secureCWWorkers' 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 I have read this application aril 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,-afoT Inspection purposes. y 1 Signature (Owner/Agent)�d(i� Date `� k r- -�- BUILDING PERMIT PERMI DATE..? // VALUATION LOT' TRACT Mo 35 28470-2 JOB SITE �+. ADDRESS 601�.�i�a�.n,NC4,RCicc i'Imm APN 77 0' MJ)1 7 OWNER CONTRACTOR/DESIGNER/ENGINEER- PAULLADW (YW .atia Rt7UZ m 437 3 QOLF COMM DR WRZ11ARE vLf uby , CIA, USE OF PERMIT SUPPLEMENTAL TO 17ERMIT 0219.702 TO PETYI DC7 CHANCIE OF W34TRAC OR TO OWNER -BUILDER WITR APPROVE13 R -LIST. A .� t'..05T OF C0.M".kTWCrf10N 0.00 pkv f '�Yj, �y_'k [(y-l�.tD JIB row �[! bn E women '48.T.�M . 3UPPJ,Z tft.?.N`4'AV,, P9RM!1T F9E 101.000-423.000 f4, 50 k A p MAR 0 5 2003 CITY OF LA QUINTA FINANCE DEPT. 'f stY7r -F rx_ t: �0mmil'C'l.' ow ���'?1(7J;PE�'99; L'�.1;y"��cx- tq ! J�Ifi071� .Y. ,41i7.1C'.FIt+7.4.• .L•SS►sr�1 �$4.50 apcl: Di/ FRIM&TYMS DUE HOW " J . RECEIPT DATE =3Y,, .DAT FIN, ED _; vj INSPEC 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 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall .Party Lath Dr,rwall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS 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 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 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: ' CITY OF LA QUINTA SUB -CONTRACTOR LIST�(y(i�5 , JOB ADDRESS 7� -s �2 1'/+1Xl j iQor.� rum PERMIT NUMBEROZro�ZOz 0303-014 OWNER AUL LAZIN0ons UILDER Own�/t- RV,6-PC(L- This form -shall -be posted on the job with the Building Inspection Card at all times in a conspicuousplace. Only persons appearing t or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance �^ of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade / Classification Contractor State Contractor's License Workers Compensation Insurance City Business License Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) KOXV--DAL I -14C. Cit 9 i S'+2�6 n d T F�� 2003 (Zile //ZO 9A,%3 / CONCRETE (C-8) . MAkA I ew__� C, - g N 1C z�6 3& 11;1 log ST k -m fuuq 40440-04033 -03 )-(-off Mo 5 S1 103 FRAMING (C75) ' J.W.1I AW4 COKIST RLWT104 g - �C (05 2 0 S TATE FOLY) 1669958 -20193 a or oy //74,2 gNO3 STRUCT. STEEL (C-51) $- ®� ,� $-- g. 8- e- MASONRY (C-29) �}NO��� arc- FvuD ( 6 DCq ZZ1-02- 0ZPLUMBING PLUM BING(C-36) W(Ll1AN ME�NIkIJI(Jk(_ ?j�p 37 0,411, Sloq. zUaKK Awetaq WC 31.7605 -oo Ol 0$X17 LATH, PLATER (C.-35) f' H • rJ • ockxA CTI ocr- e " � f, 712 log MOO; S r*=F-- FUxj+7 X 70 S 6 y- SD (/2#0,f 4014 v, (o:j? DRYWALL IC -91 JlM AQHST2toCY C --1 2f� Q!t STATE FU�n 00102�jj-2003 /-0� 730 r HVAC (C-20): f_"IC.IL" AI rI Q- � U101'1� -3$1303 S '3� ST�'TiG �i`�Q ` wl- -`to -V f iqf�eq 05,39'7 o ELECTRICAL (C-10) :: Dom} IJW(9'C_e e. T -0 T4s FV�-�� OIC( S��I -OZ ld O�SO ROOFING (C-39) AL NILI.�'L S0.YP- C 33�.5�'1 T1►'TIE �uup Za'S' 1�t5'.S' O�• l-1.0� �GD(p s/=0 SHEET. METAL (C-43): ` '.. EtCtafT Al It C ZU' 701 C1 VC, 513001 STA%f- f:�)1J 7W (rZ- 9� 0 '03 Z iZ 0 053$3 30.03 FLOORING (C:-7.5) �-J�-i117t"� —7C.fV"������A--� l ®�f' —2 I �/ -�1�-It�� GLAZING (C"'.1 7).' .: ' :: ; _• C 41kSEI-f %LASS C- I 31(a STAVE fam 5 2,9 U -e3 a 0 Pf �3 INSULATION (C-2) r :>:::..` +% C -'�.. Z%i� 5 ( 3003 Tn�V��i woet�ry JF+1�BZ'�•adt'ba o1' l0(30�03 Bi H 11 31(0(63 SEWAGE DISK -.4 CI 42) ::::: CtT PAINTING (C-33) ; ::> C7AQRljt��J TAP�aO�! 09*032-W 24?110tt, t (U>y, '-/�-' V W00"o 5,010; DO IIS $tbro3 i CE". MIC::TILE IC -5%41:.::.'::, KD C -5 67� T ,5 STA'T'E Fg1�D 17o511K-�- 1d�2 I3gvo a p 03 CABINETS (C 6) �- C4� I�.1 y. � �I /�1J 5 ir. - (p �� {�0 ! �� 105 SrAT'E FUnIt7 Ibo3 16802-. to (03 xi—et�222708 u�- X03 FENCING (C:13) 1lI TA`I W9- N p L' ' i' { ^ �O Z.� l 9 3 03 S'faTlr FU iJ?? l� jo 00 27�(- OL �?j �o l ?S S LANDSCAPING IC -271 �Uuo �A Nn S� C 2j � 3S M IOI31 (.>Jti COR C 06002. p0 3S `r 3 PUOL (C-53).:..: _ C'�' S3 6.3�8�(� 1�I3r 1"CO DuML35 V00" CITY OF LA QUINTA SUB-CONTRACTOR LIST JOB ADDRESS 42 I'AW Wq- Pay- TuW PERMIT NUMBEROLIo/zoL '0303-oly OWNER AUL LADIQ BUILDER ' O wNO/t- R cn GPC t' This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade Classifica i :: / ton Contractor State Contractor s License _ 'Workers Compensation'Insurance City BusmessYLicense Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) _ Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK IC 12►%', K�Yk>✓uoAl. SNC. l2 Ft �C SLI'Z�olc t� D d .5T-TiF �c�kjp �/D/5 ZG�- 3 (2�,0 /%ZO q16,/a,3 (; CONCRETE IC81' :c I�AQCG11 C00 C"8 NiL 30O4' STAtu� ��b`Do33-O3 /-(`a`>` OHO 5 Sl �03OK FRAMING IC-5) J.W.VAtIN ('OrlyTRuItlo►-10 (C (DJ 2 ta5q 1131STATE= FOS 1669959 "Z003 76e, ML STRUCT STEEL (C 51) NOM6Q- ®ili� �_ MASONRY (C 29) Q.091: R. r I_A-401Z CZ t (PZN6 trwe FvuD ZI-OL PLUMBING N1EC6/Jl(ArL _ 3�0 3739-410 S zug1CX Awet q WC 34766 8 -00 01 OS1'IZ %k (3 LATH; PLASTER (C=35) n '1 (' U • CO►Jr2AcT'I�Cr e "� f 712j og ro OO 5 r� FUIJ9 170 S 6 � SD thv coo/ 4 `Fizz (off V DRYWALL J(µ A4.wb a c�- 'q 381303 2�2 Qy S-rATE FU n. oo! 0231- 700 7 30 2 % r Hvac`(c 2oj E�.1�iC(t t AI Q 1A 1ol�ti°t 5 3I ST�T>� f�NU of 11_ Rto -113j. sj 053g� ELECTRICAL (C 10) (�EC�C' ��1- !-P C i C . �� I I 2 - O �TAs"� FU �� O ��( SSBI -0-2- ROOFING (C39) A L N I I,L lm >� kky2- C. 37� 5 � � 'fA'�E Z15- �t5v •e3 (.l.oy 0006 S �: SHEET METAL (C 43) �tCUq`ff Ai It C Za 70� Z, 5�;� 0 STpif. Wu tL 7�p�Z•9�e� '03 Z iZ 0 O^?�1g?J 3o 03 FLOORING (Cy15) �G Jlli�lE�j C4 (o ir7 &D S Q �ii�11 �6l.Yi' L� US 'IC)9a3'0® l 91V . (lJ2 GLAZING (C 17) C j�TrftlAS$ `p 31 bt 5t-AT l INSULATIONC TR�1009kt J9JQS1CL(.O p B 03 SEWAGE'D(SP (C 421. ' Ctj _G' -�' �. -6-- -0� A- -IS- e- -�•i �-- a- g-.� 4 y PAINTING IC 33) GA2ILljt�U TAP Oma! C _ �►32;� 1 nn �.Q.�t V�. p$' V & Poe" 00 II r CERAMIChTICE (C 54) CABINETS (t: 6)- CA� uJET�j. aq a Pow! 5 - 7���� J '�� 05 Sj'gT'E �Ur�j (1003 1802 • _ l0 (6 3 p .a=Bf3O 3 FENCING (C131 TAy tA� U4 '2" C °l 6 zq 1'1 q 3 03' S�aTE Fu uA o0 27.{ - OL o_3 �s 03 ((( LANpSCAPING (C 271�� DU u� (,A N4 S� �" C �p 3S '��� l0 31 o�i (.N'i C0� I C 00002. p0 �. _ 35 - POOL (C-531-'"`x.,.:•'`;>;: <' »> > ` C' ' s?J �0 �j�gcl (P. 1 10{3, 0 oJ6 , DUMuS �CSIGd.1�Q ©ems 1 a v L- March 4,2003 City of La Quinta To whom it may concern: By my signature on this document, I hereby authorize J. William Turpin to sign for me; for any and all permits required by the City of La Quinta. rauf Ladin - Owner