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9606-075 (AR)LICENSED CONTRACTOR DECLARATION PERMIT# CONTRCL# I hereby, affirm under penalty of perjurY.lhat,lfam licensed under provisions of 'i %y( BUILDING PERMIT 9606-07. 3516 51 6 Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DAT ( VALUATION Lor TRAc •+- CV W Professionals Code, and my License is in full. force and effect-., � --• $7,009.4Q �� L�h3$ tt O Z) co License # Lia Class Exp. Date "` (:3I JOB SITE `f APN r It+{tt5 is r� l01 31491 45-51.5 DMERTA AIR DRIVE 404-332-005 Z,Date ? -7 �' 1'�-• Signature of Contractor - !� - �" - �'�r OWNER CONTRACTOR / DESIGNER / ENGINEER �O� T �yr^� OWNER -BUILDER DECLARATION+, CUINITUPU .' Citi: pv EL11.4. ONAI,Y UNiip� li;.� C� Ni'i° Ii C:i��L�f �' �.�i (��:�i.i�syiVii'i W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's 15.5 Sea, "D" grIME-r, 8.11.1. 912.(k) 1,33 so. "i1" SxREET, sm 4200 License Law for the following reason: SAN:BH R t�iAR1►IN+ f �A 92408Sf1:I� £i( RNAEtalll�t� CA. 9240$ Z_ ( ) I, as owner of the property, or my employees with wages as their sole (909);-G( j7 l', J,t: 2320 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 contractors to construct the project (Sec. 7044, Business &. Professionals RESIDE TAL ADD).f`:I``ION' Code). <`� O I am exempt under Section B&P.C. for this reason BONUS R0_ OM i#l)Dt ([CTM - PL O N Date Signature of Owner GSC rt•'E„B FOR AD)DI•TIONAL REWfEW 0)0- Q WORKER'S COMPENSATION DECLARATION p Z I hereby affirm under penalty of perjury one of the following declarations: Lo H O O 1 have and will maintain a certificate of consent to self -insure for workers' t3�AIU5 BOOM $ft-2,Qfi Sf X W UL compensation, as provided for by Section 3700 of the Labor Code, for the m_J Q performance of the work for which this permit is issued. Q U (4r) I have and will maintain workers' compensation insurance; as'required.by O tJ Q Section 3700 of the Labor Code, for the performance of the work for which this li LO Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier l�'I N. Co. Policy No. ob 2042066"1 ESTIMATED CON -10F CCN *1_RU I0N :Q (This section need not be completed if the permit valuation is for $100.00,or less). PLAVVCMECKMX 101-000-41-9.118 () I certify that in the performance of the work forwhich this permit is issued, I shall�ot employ any person in any mannerso as tolbecome subject to the Cx3N "I'RUCTION 1 3 J,a.1-OUQ-4:lR-00th $9�7.Gtf worke'Fs' compensation laws of California, and agree"that if I should become,,-;-'"' tvf,,.0 tANj[C°Al r. C tF)I.(jC1!• 2i-i�0ii $.l .t)fi 3 subject to the workers' compensation provisions,of Section 370`0,of the,,Labor F r0 R3C 4�. FEE id1;=(f(ffJ=42U-IfC� $!t).OS C de, I shall forthwith comply with those provlslons. nI �� C te: �? I� f %r// Applicant -j ✓' "`i _.:-~':" }�i,lTMF3INal 1, f 1 -(ll}0 ?Dfs.Ofl 1y' Hr �:�, - S�'�3N lYI.0'01IOI4` FE -U.' - R S10 - 10.1-V�ii0-241-wo S.70 . Warning: Failure to secure Workers' Compensation d&e g is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000,.in 1Nf ltr�b'1'lfift�`! l�lt1- !<isf� '2fi-O�l�W3 3�i2 �t57.71 addition to the cost of compensation, damages as provided for in Section 3706 MflSCT=!•LAN03 US l.fji:`Uilii`4�3'(ff?(} $40.00 of the Labor Code, interest and attorney's fees. lNV r.11.Gi-ATION 3"L!*,Fi . 101-0110-423.000. , IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to="Yhe conditions and restrictions set forth on his application. a t 1. Each person upon whose behalf this application is made & each person att{.,. { i whose request and for whose benefit work is performed under or pursuant to t5Ul3't-Ji't1L. C©%1ST.€2UC'l'}N �lvf7t:� CHECK $Y)4.84 any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. DAMLBISS I�}i _P..0'�i rFU-$ 4` 0,00 2. Any permit issued as a result of this; application becomes null and void if E work Js not commenced within 180 days from date of issuance. of such. >i"if4 �;� lDtt'.,� �,f9df Oermit, or cessation of work f,84 or 180 days will subject permit to cancellation. DEC 1 9 t96I 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 OF LA QUINTA the above-mentioned property for inspection purposes. s 'S RECEIPT DATE BY DATE FINALED INSPECTOR Signature (Owner/Agent) Date a- q6iw, 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 POOLS - SPAS 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 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles. G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: �� P.O. BOX 1504 TEL 619-777-7012 478-495 CALLE TAMPICO INSPECTION REQUESTS LA QUINTA, CALIFORNIA 92253 619-777-7153 10 o o ° � Qol C]N g (7 D (n O - p n° vn- m,-.c m a g N sp w 1 v a w d ° ? 3 m Y 3 m CD- 0 3- m 3 cD m m � ,,.� m° D < o m ci w O m - C0 m .� _ �, °' o' o, m CD m m- o c o ° w �. 0 m r o c - in �. n m - 3 � 6 3 v cwi - c cD z- m 6 .� m 6 m N O CD = O CD n o- O� 3 O � O O. v N 7 cw< (D O °' W N r w CD O Cp w 3pcow °omw.�� 3.� ���� w�om� v ommom3 m No� 'kw0 e w cD m �. 3 v m m C) m w D m 3 _° w o? o A o - �' O 3 m w m°- Cn w o m D O n Z c e m w cD - o_ a n 3 <° o g m w 3 m m m w Q aID 3 m ° v' ° o- -_ En c O c o CD MW 3 n 3 r (n Q m o m o 3 m s Q o cmi ° o o ° m w ' o m ' = Q a s o m a° m CD m m (� CD -o m 3 Q � CD a m cwn o w m° °< m D° H 3< m 6 w 3 o 3 3 m m � c �' ° s o o O (n w 0— m 5 -o Z w 07- o 0 o Coo o v o Q w. � 3 m 5 m o m * co o-co m Cn o< ° w n w o m c v° n CD o w. -- (n cD m � 71 _0 3 m y w 3 3 o w m cD ° -5 m m m �. 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Cc) �. m w w�� -a1 m Cn Cwi CD o 0 C. p n 3 p 3 N. m Z R, o_ m e o c� w rn o C 6 �' 0 w cn _ w 3 = O w O< N N m Q? _ CD V- 3 O O O Cn 7 O co 7 a 1] _ 3 a CD m C 7 7 N CD (D a 7 N O Cn CD m (D C (Q Z O O_ U) x m m Z god 0=3 9L o o2 � c o�c3o `' oovw nCD ��_ ow m W� CD 0 w n CD —� 3 w CD 7 C CS - v ° (D O Cn n O 7 m o m j 3 �' c S 7 .°. O w a CD O `< m CD O O O - w N. O 3 moo-0o nm o oC7 CD 0- mo 33 w m- w _ m mFn. c w--< o CD c o � o CD m o n- o o w N. m w - cn o cQo' wv o3�0 �w wo wo°cm _3Q �o. >> aN n_ _ �I 0 7� O O Q CD � : 3 m O 7 °- 3 3 m cn R1 3 m= w Cn _° O _ w co � co v' ? s Z N o w v rn a o m m° m u, 6 m N m a ° m m a 'm ..y m z m D 0 m o m � _. cm .r r z < C D m I -_ m > wr mm -- .� m_ /R �- G r - - m m w y l' z - - '' .- - } .a O z _ z cf) Y m 3 0 m -oi ~' a. i D O f. zc 3-31 - cy `ia� INSPECTION RECORD OPERATION DATE INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings Slab Grade Steel Roof Deck O.K. to Wrap Framing Insulation Fireplace P.L. Fireplace T.O. 01 Party Wall Insulation Party Wall Firewall Exterior Lath Drywall - Int. Lath Final OPERATION DATE INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents T Grills Fans & Controls Condensate Lines Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Seam Approval to Cover Equipiiient 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 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