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0401-281 (RPL)LICENSED CONTRACTOR DECLARATION I hereby 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 # �[!Li�c. Class /Exp. Da,;,) 634981 //SS•�p Date �, 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&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. MATE FUND 1 4�92`i-D3 (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 pr,•ovisions'of Section 3700 of the Labor Code, I shall forthwith comply with those"provisions. 'Date: * - Applicant A) 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 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 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 property for ihspection purposes. . Signature (Owner/Agent)�� , • _ Date-" i, BUILDING PERMIT PERMIT# DATE VALUATION LOT 0401-2131 TRACT JOB SITE APN ADDRESS 51,425 CALIX JFJ1M.��' i — OWNER� CONTRACTOR /DESIGNER / EN 1NEER '�yY ) COROd. EL ENLg�MPIZIlM.13 CORONELl.O.l^IMUd.i,U©,GV - P O 1AG 13'89 51 -1 05 t+MIDA V/UJ. A If10 1 7j" C4L1:C1+s"1', % CA 922S3 LA QL:I}Xlm C—A 9225:3 C760)W-4504 C:'13Z4 2261 USE OF PERMIT 1'001, AN WOR LI A F't OUSPI A- .A.LFARMS01APJIt7Oi25 SHLALC..t E IN PLACE P.oPLAS'CElk' IiSHPO,`1`ION, L�t�F3iF'AfE1`i7' ENC L. L�Ft�? ?�tO 91Jr"'-t�fJl71�:L� P001,ANlDJt R SPA. 2,000,0913 ESQ` MATKD CoO.V.' Off,' C OITr3J.11t3CMSON €3►�Bd�b �ai3 PLAN CHECK FUE ? 01.000.439-31 S $605 CIQ'NS7,RUC'I1 ON FEE 101-000-418-000 $09.00 MXHANK" FEE - POOL 101«000-421-000 S24.0 RL RICA YBE-•POOL 101-000-420-000 $45.00 P1LUi0TJN(17ZF,-- POOL, 101-000.119-000 WIN MWlYYMT4, C t'D98TRU=0X AND 1Y'.C.W C1 -ECM $259.35 F! IMS PRE -PAID TM2 $0,00 1 JAN 2 9 2004 CITY OF LA QUINTA FINANCE DEPT. . RECEIPT DATE By'_ DATE FINALED INSPE R T 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 BLOCKWALL APPROVALS steel POOLS - SPAS 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 ,;ewer Connection Encapsulation v Gas Piping Gas Test Appliances 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) Final COMMENTS: TI .i -m^.NIGH - P51C�_.��xU.bGI.") FUNGF. i i s'1m°•141ca+ L3LLXJC UTALL Ij Q i jl i CV ' ILI ;; CO ID S�Bio�k�,�1 4 �7a_011 ( SE:'T'C3AC;K SETBACK HIGH POINT 6'-m' H4G41 i llloao I-FNCx I �p — _- _WOOD FENCE MIN, _7Iqo I TYR 1 Ll r y ,•_m. IAC C ONDENSER SET I CN 4'X4' CON_ PAD 1 I TOP ES PAD 7O BE b ® 1 NO LESS TFIPId 3• I I -- ABOVE GRADE r ttMrJER l I °ro e I 1 I I o 3' 1 47-- a Effif AM AD I e, � I 1 I = — 1�R1 I. Jyo 11HALL W70D IfNC . i I OIL1 'I 0 .PPD v 1 4,.L QdRiciBaM i ------- GATE I I � MOCK UJAI • �, � I � \ GO S I 1 'l 9 LLLnNATED STREE711YiBE" af3 VISIBLE AND LEGIBLF FkCH 7F4E STREET 6` 9 I D r' RG;Spv \7-" w S' e� , . \l �ffiygaL4Y Iwb► Nl �� DRIVEWAY APPROACH REGilIRE9 A S SEPERATE WERMIT AND NSI-ECTION FROM CITY OF LA GUNTA PU9LIC i WOWS DEPARTMENT ; P JI 0" 0'" YYJ-0 ;iETBACIG \ SETBACK