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9612-142 (SFD)U) CQ LU 0 0 C61 0 L0 W z 0 (0 �z 0) _J c) — LU LLI (D CL U) z ce) LO C\1 0 C\I 0 a) Z C:) Lo < , �Z 0 X W �= 0 _J _J co _J < < d 0 LO CY) `41 z C) _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 1 �4.18 3 1 /0, /at' -7 '1 Signature of Contractor OWN E R- B U I LD—ER:.�D��Ef�(C�A'BjA.TION�-�.' ry I hereby affirm under penalty Of perju that 1,5m exempt from the Contractor's License Law for the following reason: . i ,( ) 1, as owner of the property, or my employees with wagesiastheir sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). 1, as owner of the prope'- rty, am excilusively . contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). . I I 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 6 certificate of consent to self -insure for worke rs' compensation, as provided for by Section 3700 of the Labor Code, for. -the performance of the work for which this permit is issued. SX) I have and will maintain workers' compensation insurance, as'required by 61,ion 3700 of the Labor Code, for the performance of the- work for which , this permit is issued. My worke�s' compensation, insurance carrier & policy no.'are: Carrier Policy No. 71YRUH INS. (M. (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 CaliforniZ and agf9e'that if 1.�hp,uld-b6bbme subject to the workers' compensation proyisibms of Section -V00 of the Labor Code, I shall forthwith comply with.those-lirovis' ns. Ir I Applic��_� ate: L_ -91LI 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 wh9se behalf this application is made & each person -at whose request and fo r whose benefit work is performed under or pursuant to I any permit issued as a result of this applicaton agrees to, & shall, inclemn& 'y & hold harmless the City of La Quinta, its officers, agents and employee�. 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 informatioIi is correct. I agree to comply with all City,. and State lavV9 relating to the building construction, and hereby authorize-repres,entati'ves of this City to enter,upon the above-mentioned property-f6r-insrrctl-oe��6rposes�'� ,Zionature (Owner/Age Datd�_� PERMIT# CONTRCL# BUILDING PERMIT 9612.441 DATE VALUATION $101,7,76.1-0 LOT 7' TRACT JO540 . 1, I/Z,7/7 � 1 23 � j..1 JOB SITE ADDRESS 45-035 IMSE 14 SAIN 1) CO U ICE. 6"280-042 OWNER CONTRACTOR / DESIGNER / ENGINEER "EMIRAY C-- R-OWELL COMNIWff LES CENTUItY CROMELL C01MMUy 1535 SO. "D" STE.. #205 7" STR WOO 1515 SO, *L E El, STE J - SAN BERNARDINO CA. 02408 SAN BERN.&R-OM0 -CA 92408 ) 0 -6007 10 09)3x URI# 2114 BENJANTUN AGUILA R ASSOCIAM, USE OF PERMIT mwrMsoto .,kvs, TOPAZ@)LAQVINTANORTV 1"LAN 3)WR PLAT.4 1,TR8'MXAJ0:,T.) FOR N41ILTIPIX ISSUR OFSAMS PLAN 689.00 SY7 PORWIPATIO 106.00,W QAfU%G&CAR7k-)RT Sk' EST IMATED COST. 04' eMINSTIMMION PLAN CHECK FRE. $444.3.72 CON-41IM("TION RE, $61446,50 N4TX,HiVQCAL FOIS .101,000-421-0W 1.0 1 �000-420-W J, IS.94 1'01-0(0-419-000 $148.00 S"0,0 225-000443-142 V.246�" AKJ' rN PUTif-IC I PLAC'E's 108) 70t -WO -255-000 Al. CHEQK $3,504.78 S PRE 'D T LE S, -PP.J. FEES KOO DEC 3 0 CITY OF LA.QUINTA RECEIPT DATE BY FINALED PECTOR INSPECTION RECORD OPERATION I DATE I INSPECTOR OPERATION I DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs / 'd, Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap -7 4j� F.A.U. Framing 4� 4 9 4ga 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 /7,'-7 Final Final 71 C/ 0/ 7 1 POOLS -SPAS BLO.CKwALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval 1:6 Cover Equipment Location Underground Electric Underground PIbg. Test Final Gas Piping PLUMBING APPROVALS z / 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 171`272-7 Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS. Temp. Power Pole Underground Conduit Rough Wiring Low Voftage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) "Woly/ 7 1