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9602-070 (SFD)LICENSED CONTRACTOR DECLARATION hereby affirm 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 # Li6,16W r ExpoDat!e, Date ?— `ir^ �/SignatureofContractor OWNER -BUILDER DECLARATION I hereby affirm 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. (This section need not be completed if the permit valuation is for $100.00 or less). ( ) 1 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`itj should become subject to the workers' compensati''o p?ovisionsof Section 3700 of the Labor Code, I shall forthwith comply w(th those provision&, _ 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 application agrees to, & shall, indemnify & hold harmless the City of 1 dia�p�Wells,.'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/wigall City, an f^State9laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. . Signature (Owner/Agent DaOB J< C ALC " BUILDING PERMIT PERMITa +iGf47 11711 DATE .3/ G/961 VALUATION $T�9�y�t)� �Q LOT 83 _ TRACT 25�"-1 PRAC.1' 1T1 , JOB SITE ADDRESS " APN r _;1i.A4W;.QV,Qwi 'i i3rV OWNER CONTRACTOR AYER•S OROTAP i. FAIT 1WAyC�.4Y'S L,.��.Q9..iiirvT�• N 3Cid 111NISiiYIL �i'. 9p, 50-5215 G L.D. R 3 11i�d `.ERS E C091'A MESA CA. 92626 LA. QUINT A CA 92253 !7t A) i&"060 r_Ra .ft 1174 DESIGNEWENGINEER f�j 1��771-55? i FRA.R11,'. 0ON7AI.1 S ASSOC. .1331113AST CHAIRMAN AVE. USE OF PER'1804GL.E 1".i MILS` DWE'1.,LIN I Vtuviuu, QA 926t* (;-U10-44U LA QUTty iA kA.11ZWAYS PLAN i FEE DESCRIPTION FEES CUSTOM. CONS' PLUC1'10N 2,316.00 SH GARAGMICARPOR'f 5313.00 SF ESTIMATED COST OF CONSTRUCTION 141 PER.MTT FEE SUMMARY PLAN (,'A4 Cf{ t+,Crh 10141100439.318 $775.45 CONSTRIXTION'. ' 101 -OW -08-000 9Sf1,00 NECHANICA.L PEE 101-000-421-000 $47.00 I i,.EC^1'.k1.C'AL, FETE 101-t_100-4211- 00 $.1413.92 NUMBING xfLIF. 101-000-419-000 V'i'i•,•,$,'• p!/`+mit',7t V-0ll -1 fic-.1!!j I A IAnn t0ifI on 1►ir nr OLL k%" f01.,„J I t%J.1% FtkJ l 3l/1/-.4M1^ViN Jl d:/.btl MA©INO FEE '101.-000-123-000 S2b,ti41 INFRASTRUCrLM-6IlIF 225-000-443-342 $4.287.41 ,SRT IN Pt f 3MC l-'liNC1 S - RESTC, 701-tW-255-000 SUB-TOT.1%1. CONSTRtJMION AND PLAN CHECK. $6,S�Iit.ri4i. LESS PRE -PAID FEES Si):00 TOTAL Prix rr PIEES DUENOW 6,5Q �t;4i RECEIPT L�� ., \\ j DATE �;- 1< BY J I!. DATE FINALED 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 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 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) -07 CITY OF LA QUINTA 11Z of 0� 000DING ': .N71 i'Y DEPAf3•171`4EN'I' 777.7012 !I`:'JPEC I -ION FiEQUES'f LINE 777.7153 Owner—. FAIRWAYS I.,A QU I11'I�;�1;�_- Contractor ''YRE' (.,'R0l.T Ij P©rrn+t POST ON JOE! IN CONSPICUOUS PLACE INSPEC-FOR ALL APPLIC/\BLE SPACES 11111. 1)!tl Vl? JOB ADDRESS SFU L(.)'1'83 PLAN i TYPE OF !NSF'Er Tir.' DA(E —,_ IPSP. FOUNDATION & SE'TBACK' FOOTING STEEL MAIN GROUNL') S_YSfEM _ I GROUND PL'UMBIN�- 1'1-3E GUNITF^ DU NOT POUR CUNCR 7"E UN!'II. ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRQTiF S. ELECTRICAL 6ROUND DU NOT PUUR GUNCRE "E UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ._ ROUGH ..._. ..... .._�...__..,._._......._..._.._..__i _-_—_.�,__ N% GAS HEATING & VENT • /C FIREPLACE ROOF BOND F.iCAM Q K. TO Wf-v,' _._....�_........._....._ _.� . _ .�..._. __. GROUT 4: ' .,3;. FRAMING INSULATIUN PRE -ROUE -_-__ACOV_GR NU 'NOraK UN"ill Af3CV(c i•iAS F1EEN SiGNED,•-l�• Df';YWAL_ IPS;'ER!0n - .....__ ;-7J•,_i -(? _-� .!( _ EKI ERICIR , p'"o _�....._.� PUUL Pf'iE PI.A.,rL:•, ; .,........... POOL FENCE & GAYE SEWER SEPTIC T; rf K _ _� �.�.7 FINALS —LE ELECTRICAL •�--r�- PLUMBING .._FINAL GAS —,._._TEST H-.„..._—_._.._.-_—_..._.�__.,.._ --•' HEATING • A/C HOUSE t�UMF3ER� - JOB COMPLETED TEMP POWER i A601c APPROVALA' D'? RIGHT TO 1 96 T+LITI::c i R —X—,. UPY nuILDING