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0209-093 (SFD)syn:. a LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE - VALUATION LO 'Professionals Code, and my License is in full force and effect. �' ., •License # Lic. Class Exp. Date Y JOB SITE 53 .10 P .hic '13301/02 ADDRESS ,� •��l VAT;6..E�P•C7A1� C.t�"'SJF$�'' OWNER Date ~Signature of Contractor— OWNER-BUILDER ontractor •air _ OWNER -BUILDER DECLARATION SMONA C)I , INC I hereby affirm under penalty of perjury that I am exempt from the Contractor's i 7'564 C"t�i MMM 0AX6.L ,, 3YM .7 License Law for.the following reason: PA?. MMIR.a" +;.:A. 92211 ( ) 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). . USE OF PERMIT ( ) • I, as owner of the property, am exclusively contracting with licensed SINGI FANW ° i9WTK'1J_W6 contractors to construct the .project (Sec. 7044, Business & Professionals PERMIT # T 18 APN TRACT CONTRACTOR/DESIGNER/ENGINEER _ 77-eA5ACOMMRYCLITBD.RIV.E.ULTffL' 150 PA%a.q Dl?" 1 CA =60 (760)772x4224 MLO 1137 Code)INCLUDE LOCK.'WAT S,C£O.LA3?fB () I am exempt under Section , B&P.C. for this reason P0014 SRA OR DAIVEWAY A.PPROt1i' H. 7.1% REDUCTION TO PLAN 04,FXK Date Signature of. Owner "I DUE TO Ad•ULTIPLE ISSUANCE OF SAME I-LA14 TYPE 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 foe which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier T TR FUND Policy No. 1 07142 (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 fortliwith comply with those provisions. v6ate: %/ ':i ,i'1 "Applicant ._�-.. f Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject anemployer 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 �cancella4icim . 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 We above-mentioned property for inspection purposes. Y gnature (Owner/Agent).,�--^' Date''%' C111STOM. CUNSTft•UCTION ?,490,00 YF' POR.C' .PATIO 123, 00 S? OARA0Fj1=P0TtT 6143,00 �F ; FSTDMI'.I P, COST 01f' I;"•C3NS" WII'ION CCa?�i5�'�,.l�C'F,If'�2� ISE 4...t,.. •� Y"t3? �Cliit)��t 1 �i��kGO �1,4.17.�G; PLA14 Cifl-' :C- rfe[P, MCHANICAL FEE 1011 4000.4.21 -000., 5109100 ELECTRICAL FEE i 011 �OGiy-�B•2A-GQG �t3,.�6 PLUMBINE? F ? r� t .ppp.4? 9w�1t�q 1317;�.4fi S"i`RMIG 10,07ION FEE . ,R SID 101-000-241-000 '&200.79 13f:.t1.1 ING M 101-000-423-000-. 00.423.000', $15,00 DE'1E i?1..C;iI'AR IMPAC' F.0 V2,405.0tt M;l' N PUBLIC PIA.CE0 - RME 270,006445-000. �19.St1 ..K ,SUB -TOTAL, rq1rdTRUMON AND }?Ul T MC:1''. LB -8,16i 'P. IZ, -PA DMO IO SEP 2 7 1002 CITY OF. LA QUINTA ( DATE FINALED 247,02.2-'3? 19,0921.75 S0100 S4.m.°r5 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings /Zp _© - Ducts Slab Grade-' — oz Return Air ` Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing — -�z Compressor Insulation — Z 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 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 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) —