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0006-098 (PLBG)LICENSED CONTRACTOR DECLARATION: !,,hereby affirm under penalty of perjury that I am licensed under provisions of �d6pter 9 (commencing with Section 7000) of Division 3 of -the Business and Profes,Jbnals Code, and my, License is in full force and effect. License # Lic. Class Exp: Date ,61(?554 B C'36 05/31/2( /Date �'""Signature'of Contractor �I�4G�J-^�^"' « OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that Ilam 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 F�?iPA+1PT 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 worke`rs'v.compensation laws of California, and agree that if. I should become subfect;to'the, workers' compensation provisions of Section' 3700 of the Labor Cde;.a s'halGforthwith comply with thos provisions: �f ate:. Applicant 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 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 Itthe�'hove-mentioned property for inspection purposes. 1/7 Signature (Owne r/Agent) � Date��' BUILDING PERMIT PERMIT# / 00O -M DATE VALUATION LOT TRACT $6,42390 JOB SITE APN ADDRESS 44 -fes MMODSHa OWNER CONTRACTOR/DESIGNER/EN (NEER C'LEVO bdomr 011IMEMBU ME:R 44.095 SM+"TBU3F3 44.095 '45WF.8*f BUSH LA QUIN TA CSA 92253 LSP. QTWfA C.A. 92253 MIA 5039 USE OF PERMIT Px.,i31�rlJ�Il�iC3 Cf VEM PATIO 493 $Q. iii'. EXT 1350. QAS L1NP PORC'HIPA.TIO 40.00 SF AIXD COST OF 1..Wd�iSAAY©MON 6.423.90 gy3Efi3�'Zdl' py�t�yx FEE .A" F3x.6 A FY3'+Jl7.i SUAMA .8 PLUMBING FEE 10)-000-439-000 $16.00 CONS,riz JCTION Fie 101-000-418-000 $90.00 PLAN CHECK FEE 101.0()0-439-,318 $58,30 STRONG MOTION F'ZF: d +10 101-000-M-000 1-000 $.64 . fes. ffUB- IVfAL CON "T UMON AND PL AW CIMCK tO $,f;67.14 ISS PRE -PAM FM $0.00 TOTAL AL. i'II IrFM DUE NOW 5167,14 RECEIPT DATE a / f / s% DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings L, q - C6 r Ducts Slab Grade Return Air Steel Combustion Air Roof Deck -1.40 to Exhaust Fans OX 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 I tK BLOCKWALL APPROVALS Final POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I 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 tII • 1 -Qj� 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:..