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0104-056 (RPL)U) I— t• (V W o�C) W o Z l� �Oo I— ~a fl - CO Z M U) N O� CL Q U— Z T CC Q O 0 J Q C0 _J O li a) 1-t Z_ oo —) r0 R 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 wd effect. License'# Lic. Class '.j Exp. Date L.53p' I ; f ll�/�?/�Di Signature of Contractc OWNER -BUILDER DECLARATION ffJ 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 SeGfion 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. (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 provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 3 Date: Applicants r •' `• , Warning: Failure to secure Workers' Compensation coverage is unlawful an shall subject an employer to criminal penalties and civil fines up to $100,000, i addition to the cost of compensation, damages as provided for in Section 370 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safe for a permit subject to the conditions and restrictions set forth' on hi application. 1. Each person upon whose behalf this application is made & each person t whose request and for whose benefit work is performed under or pursuant t 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 (Owne—gent) ����t � w? �'* Date I. f 11 v .a;...s. F. - BUILDING PERMIT PERMT# DATEVALUATION LOT TRACT 3 .,U) Q1.t3C) 1 t9 JOB SITE APN � ADDRESS OWNER CONTRACTOR/DESIGNER/EN INEER PAUL E'VVISS ANMICM, POOL CO�4'�74CUtv:`L'10N 54-9.23 ,AXEMMf*".sDIA-7, 73960A -W- W.AY 91 x LA QU.►1T1A CA 92253 PAW 2i MAW CA 92255-1S �6�1�3�dCA-.2SSS CRLft ]1t}4• USE OF PERMIT PCS, APID/0L, WA 1.1001.. A1, AR MS111ARR1,ERS' SF1Af..8. 39114 PL ACY AT FIR&PLASTE:R 13+T�101sC�T.Frb1�'. I�`t�iE. fr..,QUz&+1�'➢E?'t�fi' k:P�it'!Ej•3`3�t�1�Af�'i`1` 11~tL'i.,C.luE+.L�. S"001, ANWOR. SPAS 1A000100 0 L, S HOW CIHZ K EPEE 101-100.4.19•.118 1¢3.60 CONSTRUC11TION M 101 -000 -418 -OW $144.6 ME4fi9N1;AFRE -. POOL 101 -000 -dM -000 S A.04 Fir3="!'fdtCAY.. FPZ- POOL 101-000•420-(M �49,f1E1 PLUM81190 FEE --1't OL, 101.080.419-000 W APR 1 1 2001 CITY OF LA OUINTA FINANCE MD PI.A9 MaKIK, $333.60 zv� .s�T :6.yi�°.1••a-PAM FEW $LR.fli? • �■ y ++•• ���ra r �.sd.1.1IF9yr 2rms 1'✓ s17Q)RS X9.-610 RECEIPT DATE ( �� �•.� BY DAT FINALED INSPECTOR 2.10-0 VV 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 8 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 �l Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test L G 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 Lav Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: } E-S11J�" D�Ct/ 9 P �pa PMS 'I � 14 20 = mw—l"rai — — . III — — — PROPERTY LM OU . UTILITY POLEJO JJNCT10N BOX ® HOSE BIB -- -- -- UTILITY EASEMENT V ELEC. PANEL © BLOWER --- FLL LINE - FENCE (HEIGHT,TYPE) O GAS METER Q VOTER LEVELER OF FILTER —E—E— UNDERGROUND ELEC.BENCH MARK llREMOTE WLVE H� HEATER —G—G— W)ERGROUND GAS — OVERHEAD ELEC. WATER DEPTH ® GATE VALVE !�0 MAIN DRAIN — -- OVERHEAD TELE. RAI $ SWITCH © P TRAP ® ELEC. PEDESTAL ACCESS 0 RECEPTACLE —,--3 STUB NOTES: �ovL-- I'4!x Z-41 7-50 1000 e� 0 AREA MAP EA Rl. INCTION FEE OF $30 KEY MAP NO. WILL 3 E C RGED IF THE APPROVED PLAN AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED I < /V NO EXCEPTIONS! _ Lel,, ► Arfa- -CITY OF LA OUIN - UItDING & SAFETY DE,-' , APPROVED FOR COIVSTRUCTIC'�, LIC. ** 5.1874 a•sroT NAME kA61d0/ i9V, A) S ADOR 4zo - 16 4utc A 1 YA Z LA -4u iAllh , (A• 61Z.5-3 LOT -10 BLOCK SEC . TELE. W 1 67MM- mm, ==,In, 0!'7101, Wwbw-w��--wppwA ;` AA/rR 1 CAN n UUUL � � /;()VCTRI lCT i ON R0. BOX 11996 PALM DESERT CA. (760) 322-6E,6T"'