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9910-084 (RPL)LICENSED CONTRACTOR DECLARATION I he�pby affirm under penalty of perjury 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 # Lic. Class Exp Date l b ,te 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). . exempt under Section B&P.C. for this reason e 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 ptnance 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: Career Policy No. (This section need not be completed if the.permit valuation.is Ofor, $100.00 or. less). () I certify that in the performance of the work fov whichijthis permit is issued', I shall not employ any person in any manner soasito�become subject to the workers" compensationjaws,of California, and 7gree that if 4 should become subject to the orkers',compensatibh-provisions of -�ecUo 3700 of the Labor o1, e, l h �i Lclth comply with those proJsiofrs Me: � 1t '{ XPRlicant Warning: Failure to secure Workers' Compe ation coverage is unlawful -and 9 shall subject an employer to criminal penalties and civil fi es up to $100,000, in addition to the cost of compensation,'damages as provide or in�S,ection 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 upori 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, 8 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 wlll1subject permit to cancellation. I certify, that I have read thls.applidaation and,statethat 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 property for inspection purposes Sir ature (Owner/Agent) '"' ' ' /'!� Date BUILDING PERMIT . PERMIT# 99114i4"i4 DATE ,ra' ,i VALUATIONLOT TRACT ice' i JOEI p�[r�,,�! ADDRESS I%�'.180 LAI t.�i.R.rtr A APN OWNER CONTRACTOR /DESIGNER /ENGINEER Nluilyiip UAD tNIT.i96CV'JOL .lMTJTt.t%NON 7&-79*LAPALMA 73960Hi0lLtVAYiI.i .[.A QUKUL CA 42253 PALM IJESEWf CA 9'„4.255-•t'45 USE OF PERMIT !'OUL ANEft: R SPA P00L w SPAONLY. .4i� Rita s.i'3AIWMS, 911A . M, NO PLACM XY 1100L hL'Pv`I:irt)RSPA 23,000.00 LS WR IgI ',",'EID COST OF a 4.'O:f.1.9S,R.MAU i 01.'4 � �• r h.3C'7�'/tl4,7eoe Pt AN HEC K FEE 101-00-43MI8 c;'ONST:iaUMION FE Al0 "VIEMMINVI'1'i.i TIMS ,._ P0011 101-000-421-000 HIEC RICAJ, i 13 . POOL, I0-4?=�+4100 5, c� t14t , rL' U1VBJ. 0 F'-•:I?tX)J,.. 101-M-419-000 -cit3�f-419-000 S 7 . e,.tf<t ; , '0 �t��-''�C31,.:A.�., �'tt?tij°s`�.7'�'�s'1 ►�t.f'�?��; r�9.�1A; r}�I�.-f •�� �,#�;t_ `d.(3 ' .COTAXPE ?l'1iS DAW N..O y •N482.10 RECEIPT DATE BY Y " 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 I 4 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond 0 Footings Bond Beam Main Drain Approval to Cover /7 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 Sewer Connection Pool Cover 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) �z l� '8 NOW Sam R I ON b 1 04MM Iff—om iw.w�%70 , ft""�w doF, pa-�I!b // Il �/l JDA �U ti C �I DAIS ill ho L PA J CITY OF LAQUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTIO DATE Y216tolBY NOTES: I 1 ' d- 1� .cy q 4 89-I UMN FEE OF $30 VXLKCHARGED IF THE APPROVED AND JOB CARD ARE NOT ON Ul = fOR A SCHEDULED AREA MAP KEY MAP NO. v LIC. 518742 /QAVWArn ��n� �CoNTRAncT " accts NAME Lu L6,l r s C 14AI r -Al I 3 ,D .12)+u LgARS ADDP- /,A PALMA -- c,,,CALE : -IL- I, - O' LOT BLOCK SEG .TELE. g674W TELE._._ AMER 1 CAN . uCCL CONSTvJ jcT ION R 0. BOX 11996 PALM_DESER-T—C-A. (76 0) 322- 666 II I I vJ I I . i — — — PROPERTY LNE QU UTILITY POLE DJ .AINCTIDN BOX ® HOSE BIB SKKlMER DECK�DRAII -- -- -- UTILITY EASEMENT OE ELEC. PANEL 08 BLOWER --- FILL LINE LIGHT Qq AREA DRAIN �^--�-- FENCE (HEIGHT, TYPE) O GAS METER O VATER LEVELER OF FILTER -�+�, DR. RETURrI =_= PVC DRAIN • —E—E— UNDERGROUND ELEC. BENCH 'MARK REMOTE V4LVEHO HEATER —+ THERAPY GRAB RAILS —G—G— UNDERGROUND GAS -�— OVERHEAD ELEC. • WATER DEPTH ® GATE VALVE D O MAIN DRAIN -� AERATOR LADDER OVERHEI TELE: RA1 = SWITCH ©P TRAP o PUMP _- . ®GAS GRILL ® ELEC. PEDESTAL_ ACCESS => QD RECEPTACLE ] STUB b CUP ANCKIR Q SEE NOTES dSHOP ORAVHICbiACCUPRESS // Il �/l JDA �U ti C �I DAIS ill ho L PA J CITY OF LAQUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTIO DATE Y216tolBY NOTES: I 1 ' d- 1� .cy q 4 89-I UMN FEE OF $30 VXLKCHARGED IF THE APPROVED AND JOB CARD ARE NOT ON Ul = fOR A SCHEDULED AREA MAP KEY MAP NO. v LIC. 518742 /QAVWArn ��n� �CoNTRAncT " accts NAME Lu L6,l r s C 14AI r -Al I 3 ,D .12)+u LgARS ADDP- /,A PALMA -- c,,,CALE : -IL- I, - O' LOT BLOCK SEG .TELE. g674W TELE._._ AMER 1 CAN . uCCL CONSTvJ jcT ION R 0. BOX 11996 PALM_DESER-T—C-A. (76 0) 322- 666