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0212-171 (RPL)LICENSED CONTRACTOR DECLARATION ; I hereby affirm. under penalty of perjury thatil am licensed under provisions of` r, Chapter 9 (commencing with Section 7000) yof Division 3 of the Business and' Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 614611 G5 311031. .D'ate S Signature of Contractor ' 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 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&RC. 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 per is issued. (t) 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 STATE FUND Policy No. 0403046702 (This section need not be completed if the permit valuation is for $100.00 or less). () I CeRify-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 forthwith comply iv,iith,,those prove loons. Date: Applicant .^ Warning: Failure to secure Workers"Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,00 + 71r addition to the cost of compensation, damages as provided for in Section 3 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 Is 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 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 isnot 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 the above-mentioned roperty for inspection purposes. r Si nature (Owner/A ent)-d-"~ y'.. �� Date PERMIT# ' �aUI:LDING PERMIT DATE/ VA'L'UATION LOT TRACT JOB SITE, ADDRESS ' e ArArA a�'...KCXA C 01 APN I -Cr, '50-565 OWNER CONTRACTOR / DESIGNER,/ EN INEER _+ W. )O A..JJO1 S, WC MU1<'3`1-M 1'00:.Z ., WAS -7-71 w5 64 CO'M.4-TRY MM DR= SUITE 117 P.0, BOX 1791 f�E L:i�ax 3r Kr CA 922.91 :,AQY:3MM CA 92253. MAX 194.5 Y USE OF PERMIT MCA, ANWOR SPA, PC1OUSP_A° .t3.1.A_WW5Af.;2�h tS ;51-CAU,ifi.;.lfil PJ A.CEAl' P&*),PLA3TM19 IMPEC'iIOW. t► PO1 L.AidD/Oh NPA L -S ' ESMAM COST OF CONIU.;'.4U�:":1 ION .15.( m PLAN CHMt11C FEE, ➢t11w�t0©-�13�-3�� "��11 a:�£+ CONSTPLUCTIOhl +T'1'r@ MECHANICAT.,IFES--POOL 101-000-423.00 52440 F,L,WTR1CAL.IY E -- POO 1 C9 fd6d� �S�S1-tFnt� Ipv35.t2G PLUMBING FEY,^ -3'0014 101Y030h41,9.000 Srt ,0 01 Jr 2�AOv U; CUIN" iFWAvicr. CrE ,••'--'••' ,Ss Ly.yy 1110. 00 . . O 4..iL .L..R:O.S=J Y.V¢,F_` ]YOM -NOW RECEIPT DATE/ DATE FINALED a INSPECTO 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 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 Rdugh Wiring Low Voltage Wiring Fixtures 'Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) a:�•°//./,. •1 V� ^y •. ' • f4 y p •t .- '• to .'; i �o •' .•n_ � •+ `•r •, _ c� ; , 4. _ , '. ` - r ,• , I� CITY" OF-LA•=QUINTA , r ' '"�' t , _ ;, k. ; '` • ' ; - ; . BUILDING:& SAFETY.DEPT.APPROVED - z'FOR ONSTRUCTIO { ` .' ' •� '�. ` y /.' ." �.' " . L.. , � • ` _ ' - _,` • ' '. • • R. ; DATE BY . `+. �: •. _:. ' . _- •. � • .. s •,. 4t - R i F CATCH Y BOULDERS w, -24 f'- i!• _• y '_ ` � ... - •• +. ` • ur r • ' '* }' a •I. s• x ..} ` _. � i , .. ' • ; ' L�l1KE'_ �; r • ° ,, A. RE INSPECTION ` FEE.OF $30 , ' a * ,� �F INFINITY ,_ f , r . WILL BE CHARGED IFTHEAPPROVED', - °LANS.AND 106 CARE ARE NOT ON +. .THE 'SITE, FOR'.`•A •SCHEDULED ..INSPECTION f• -FIRE PIT .NO EXCEPTIONS! • - _ ' i } r • . A r !• ! • _ _ ` ., k' • 1 �' • • R. . I fit, — . '.. ' . , • , r LAKE • . Y A is - fi ,. i t `• C • • 1. . • _ :109, —3#o , PEBBLE �4�4 „ �. ; t FIN�SHs �' 4 ; r + TANNING' 7 36, • 'ws , . PL . SHELF r t _ .. a _'+` . _.' . , c a _ ... .0 z +• ..ms's„ IL 7- x, 7 SPA , • , � . - r .. � .. , : - RAISED VIM - - :EXPOSED J -; STACKED , . s ,r > * AGGFEGATE y. �: , s ;�-.. '. .STONE • _ r�� r_ ; •` - DECK-_ .. ;. P 1 �. -, a +CATCH ; _ • A.. ;'' . ' K . ; . ..� . . r BASIN .. ,. r' _ "'• +'••• ?. :rte '• - - • ' BBQ WATER t PL TROUGH ' .t 3 -BELOW . 4 DECK so . T 11. .✓� �0