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0201-230 (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 # Lic.�Class` Exp. Date '3Ci2S� C5> � i1 j Date �s! t3 7 Signature of Contractor'' r r 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 1' 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. 'V) 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 EXEMPT - Policy No. (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 rof California, and agree that if I should become subject to the workers' compensation provisions of S ction 3 -00 ©#the Labor Code, I shall forthwith comply with those, r ovislon's. Date:? Applicant I VAV J if *r. Warning: Failure to secure Wprkers;{ Com ensation coverage is unlawful and shall subject an employer to cri,minal`penalfies 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- authorizer representatives of this City to enter upon the above-mentioned property for inspect purposes . Signature (Owner/Agent)~`�'�''���^s� Dated BUILDING PERMIT PERMIT# DATE LOT C! �I-.:+SS TRACT VALUATIONS • r (/: JOB SITE w ADDRESS 5-01 0)DX,' J:R*r SAND (,3t. APN _ OWNER v ` CONTRACTOR / DESIGNER / ENGINEER 45.-,070 URL"MM,C UAN:D Cr 82.762 L'sC.A. 92253 11=0 CA, 92255 Cm*)z7 5-"03 1 USE OF PERMIT '(10011 ANDIMN. SPA P001,, 1'D SPA ONLY. ALA RMSiDAPM.E m; �I�YI iONLLNMJ31 i C' r tip. I NS-PECTION-H 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 82---&_ - Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric --� -- S Underground Plbg. Test Final I I PLUMBING APPROVALS Gas Piping 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: i 1 OF LA QUINTA (T;G & SAFETY DEPT. FOR CONSTRUCTION DA (780) 27S-840 INDIO, CA u- 4 GENERAL SPECIFICATIONS cusro •. KCLLY [3L2Iv5 A 3 -OIC G2SE2r 5AN10 COL -121 LAO!) In rA APPROJED BY: THIS DRAWNG REMAINS THE PROPERTY OF SUNRISE POOLS. REPRODUCTION OR UNAUTHORIZED USE WTHOUT PERMISSION IS PROHIBITED. g� G ���-CITY OF LA QUINTA SUB -CONTRACTOR LIST - • - JOB ADDRESS '-� I a �et/� -�i 4-- PERMIT NUMBER OWNER BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of buildinq permit. For each applicable trade. all information reauested below must be comnleteci by annlirant_ "On FiIP" is not an arrpntahle resnnnsa_ Trade / Classification Contractor State Contractor's License Workers: Compensation:Insurance City Business License Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) CONCRETE (C-8) FRAMING (C-5) ' STRUCT. STEEL (C-51) MASONRY (C-29) PLUMBING (C-36) . LATH; PLASTER IC=35)�Ci i7 7/31 O �-e c� Q `E b - C� C7 1 i o Co 4 . y O DRYWALL (C-9) . <..: HVAC. IC -20) ELECTRICAL .(C=10)'. ROOFING (C-39).> SHEET METAL '(C-43) FLOORING'(C=16) " GLAZING INSULATION .IC -2) SEWAGE:DISP. (C'42) PAINTING (C-33)`.:'.. CERAMIC TILE (C-54) CABINETS -(C-6) FENCING (C=13) :; LANDSCAPING (C.-27) POOL (C-53) �� v, r� r e L 5� C '� 8 0� (. O lin+G� � v� 0 U � Q 0 �� 30 � (� � las � Y-:-2 d : Z 7--:1