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0209-097 (SFD)-�" LICENSED. CONTRACTOR DECLARATION T'.)UMUDW 60AQ1l&ARY �'_d hereby'afflrm under penalty,of perjury thatl am licensed under provisions of p BUILDING PERMIT Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT Professionals Code, and rry License is in full force and effect. $22650 (` �� License # Lifc..``Class Exp. DateJOB ;i B hic W30102 SITE ADDRESS $D? 7 0 VA4:LYMC1A Com- I�JMv tri V Z$.f;cTR1C.Af.; IM1? Z 07-(JCg(3�420-Od3C1, wDate - Signature Of Contractor - OWNER - -_ ___ _-_- �,RL,..-.._...+-•+'-.'-' __ _ _ __-- OWNER -BUILDER DECLARATION 5%C�°a6.tS.JAV �.5,7\,3.,�. pdS'¢E.: 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's 77.564 C£71+tN"i'RY CLUB DR!'tJii sum, 1 "47 License Law for the following reason: 4 CA 922 }'s. ( ) 1, as owner of the property, or my employees with wages as their sole :T compensation, will do the work, and the s06cture is not intended or offered for sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT ( ) 1, as owner of the property, am exclusively contracting with licensed MOM F A1tdX1._Y :%"11�Ia�.,T�A�G contractors to construct the project (Sec. 7044, Business & Professionals PERMIT J/ TRACT SJ.f� 3(7l��tia CONTRACTOR / DESIGNER /EN 1NEERR SFiRO.CdqqR011d014 .M.Yx �F`'a'�°li'•R 0,A 92260 (76()71/2.822,4 C'lq,# 1137 Code). I I I I SFD x IAT 3:d PLAN 3 . PERMIT DOES NOT DIC1,t3X; R, 81XJC Wil' %L44 () I am exempt under Section B&P.C. for this reason POOL, ;aP,,l1r OR D.1�T� .A Y APPR.OAOTi, `�'3Wo IRlFaf)UC'1'10 TO P1:,� N CHL+CK Date Signature of Owner DtR DUZ TO MULTIPLE E ISSUANCE OF SAME PL.AN TYP 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. ( r)° 1 -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 FFATE FVD Policy No. 0715.1 } (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 fort with comply with those provisions. %pate. ca ` . ^ -. , Z, APPlicant .� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 37,06 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his .Application. 1. Each person upon whose behalf this application -is made & each person at whose request and for whose benefit work is performed under or pursuantto: any permit issued as a result of this applicaton agrees to,.& shall, indemnify.' & hold harmless the City of La •Quinta, its officers, agents -and employees.: 2. Any permit issued as a result of this application becomes null and'void if j work is not commenced within 180 days from date of issuance of ,such permit, or cessation of work for 180 days will subject permit to cancellation. 7 I certify that I have read this application and state: that the above.nformation is correct. I agree to comply/ all City, and State laws relating to the building construction, and hereby authorize representatives of this City 'to"enter upon the above-mentioned propertyfor inspection purposes. Si nature (Owner/Agent). "° Date CUSTOM CONSTRUCTION 2741.00 SF Pi3Rt;.TiIPAT,{O' 210.00 SF CA'R.A,GWARPORT 513.00 RF .FSTWA7W COST OF CCJMMI (Mm T'.)UMUDW 60AQ1l&ARY CONSTRUCTION f'�E', 101-000-410-000 � 3110184.09 PLAW C.hfEi`1.' F" 101-000-43.9-318 MWXAN1'C:.tAG FRF. 101 -C100 -x-21.000 Z$.f;cTR1C.Af.; IM1? Z 07-(JCg(3�420-Od3C1, 'tv139. 0 PLUMBING F91?, 101-000-419-000 50125 STRON(. MOTION IME - RESID 101 -OW -241-000 GRAD11110 FEE 101-000-423.000 D! EI -A` PE•R..11d1PACT FEEZ ART IN PUBLIC PLAC 09 - RU41JIT 270-000.4445.000 8 1W AL C`©1�.>�"i'RtT� AMPLAN 01HUM u SEP 27 ZU02 DATE FINALED I INSPECTOR O INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs — 2 Underground Ducts Forms & Footings _ / 2 Z Ducts Slab Grade Return Air Steel Combustion Air Roof Deck q Exhaust Fans O.K. to Wrap i F.A.U. Framing Compressor Insulation —per Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath ; Drywall - Int. Lath i Final _ Z_ Final 2—TSPOOLS BLOCKWALL APPROVALS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PIN. 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 Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power i Final Utility Notice (Perm) - COMMENTS: