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0403-249 (RPL)U) H _N U) W O � M �QU•) W J_ Z Q 0 o J U � W W F- a U) Z M LO N O0) CL g It Z LO-cr 0 LL J Q mQU du QMH "t Z cob 5. O Q J 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 # Lic. Class Exp. Date s Date"' + Signature of Contr" C_....-- 4- 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). O 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 Sec4iori' 3700 of the Labor Code, for the performance of the work for which this pe rmit:is issued. My workers' compensation insurance carrier & policy no. are: ,Gamer•" Policy No. co i14�•fS14S-�b�� (This; section need not be completed if the permit valuation is for $100.00 or less). ;(°),' 1•certify'that in the performance of the work for which this permit is issued, [�h&lkniot 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' compensatio'njprovisions of SectioW.3700 of the Labor Code,-1-shall4orthwith comply witJhirthose prove ions(/ • ? Date: L Applicant UeA' ',�.� P Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an -employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all,City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property°for`inspection purposes? Signature (Owner/Agent)�!�� Date.?,- BUILDING PERMIT PERMIT# DATE yr VALUATION LOT TRACT f % e. / ,.171000 P JOB SITE�tt� APN ADDRESS .�•y •�•�r .D!Lah,,K t :eiii� BJ c�i.0 it Q - OWNER$ CONTRACTOR / DESIGNER / EN (NEER TP,A)3s Enid S r n'.-JU9114G LrIc CA iF OR & POOL 1 A SPM (raP MAN 001k 99.68 HLBERT U1' M ) 02 86.100 ,fla'l9EMMI 54 SAW MEMO CA 92111 Ct?AZIr.ThILLA CA 92236 (760)398r9222. C`ALO 00355 USE OF PERMIT FLOC. "D/Ulf IMN POm;A.,.Nrj SPA oi,&Y, A -I s`t.I2M-S 0AJZP, ZRS SHALL BE I'M P.L.ACE MIOR TO 110.9PL•ASTE R 1NSWECTSOK f)CK�S.1:>G!i�.�.i!'I"AENT 104C'.I,S�SLl1�.k� A10'1' INCLU.EN D n4 !a!?-FcAaT T. POOL ANIDIOR SPA E,: !ice? COR OF C 0,14STR'fiC1.'.fO:N PI&14 C11 1i F1r 10) -000.139.31 CONSTRUCTION FEE 10'.1-000-419 000 �iSi7.61 •� MUCHMUC.AL rfF 101.>.000-421-000 Of0 Iv1eA.CNNF3Ay��•gqd��iyyCppyA.l.yy`E77rEpit,•ry1/3fy0I• `101-(C�3L�0ry_-4q'�71 ©01 pSep!4.t?L+ 10 1 0 PLU&4!)1V, 017'3 — POOL 101-Ot30-419-C:QQ :� %. �J i ��-�.trt.€�,, c;�t��xttt-�rtc�aJF�It� �js:�ai"a• L:t�L� Rr.p41n�,ci si �:iy.,;,tit� n rm "­__ RECEIPT DATE BY? /t DAT6FINAIDD.,o ( /lF_' �IYL X11 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 POOLS - SPAS BLOCI(WALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover I'd Equipment Location Underground Electric Lt ' Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS EacTesttric nal 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 G`/, ' 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)