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9710-170 (BLCK)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 Date Signature of Contractor 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-- ---,2;�.. WORKER'S COMPENSATION DECLARATJ.ON I hereby affirm under penalty of perjury one of the following declarations: ( ) .1 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. ( .,)shave 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 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. Date: /_g_ J_- Applicant �_ 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 s 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)-• tom- -� ��^" Date +�✓ * �P PERMIT# BUILDING PERMIT CONTROLk ro DATE VALUATION LOT 9710-•170 TRACT S A6 1, 10130/97 $3,.176.05 JOB SITE APN ADDRESS 78-970 DRYME K OWNER CONTRACTOR/DESIGNER/ENGINEER LOUIS RUE OWNER/BUILDER ` 13040 'LA. CROSSE A -VE GI AND TERRACE CA CI1L4 USE OF PERMIT [iii' i'i 1`Tf OWNM TsiilLDER RLOCts'.it'ALL 9;L[ ra-16' jVt4D 3 LI CO),". WC)tRKIMAKS .. CON P ATTACHM 6 FT. WALL 95,00 :LF 5 PT. WALL 37.00 LI: ESTIMATE) COST OF CONS RUCT1ON �,17ti.4I`.s PERMIT F&C 3iJiVCAM.R1' CONSTRUCTION FEE 101.-000-418-0013 1;ri.Ufl 01) C—) C " tdv SLIB--'1CTAA.L CONSTR1.fG'f ON AN)) PLM CHECK� �Fi�.pti Lt?SS .PRE -PAR) f -E S $0.00 TOTi%L PERMIT FEES DUE NOW ' " .. $63.00 � RECEIPT DATE BY DATE FINALED INSPECTOR 'f 4 �w �L� 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 Wail Insulation Condensate Lines Party Wail Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 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) #R City of Qin i La u to Building a Safety Division P.O. Box 1504 P"rm><ll i':<>>'>> 78-495 Ile Ta .:..::..:.:..:::..: Ca mpico La Quinta CA 92253. Building Permit Application cation andTr TrackingSheet • Owner's Name: OAddress: °City,ST, Zip: �Telepho 'Project Descriptions: �� _ L, . G GAP—P0) ) LJALL L.F. 5Gae09;tl v)Ai-- Construction Type: Occupancy: Project type (circle one): New Add'n Alter Repair Demo Sq. Ft.: # Stories: # Units: Estimated Value of Proiect: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES N0. PLUMBING FEES *ST FL. SO FT a 2ND FL. POR. GAR SAR P WALL ESTIMATED CONSTRUCTION $ UNITS A.C. UNIT SO. FT. YARD SPKLR SYSTEM :3 MOBILEHOME SVC. SO. FT �g BAR SINK SO FT. „T POWER OUTLET ROOF DRAINS j0. FT 4 DRAINAGE PIPING SO FT %L DRINKING FOUNTAIN SO rT. R URINAL VALUATION S WATER PIPING NOTE: Not to be Lseo as property :aa +a:oanon OTHER APPJEOUIP. FLOOR DRAIN MECHANICAL FEES TEMP. POLE WATER SOFTENER VENT SYSTEM PAN EVAP.COOL HOOD SIGN WASH ER(AUTOM DISHI APPLIANCE DRYER FINAL INSP. GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED WATER SYSTEM LAUNDRYTRAY AIR HANDLING UNIT CFM of KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE. TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. e. c BATH TUB SO. Fr. ,0 c WATER HEATER MAX. HEATER OUTPUT. B.T.U. SO. FT. RESID rd 1!m c SEWAGE DISPOSAL " SO.FT.GAR a x.c HOUSE SEWER : GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING d AIR GOND. SOLAR SETBACK GROUND PLUMBING' UNDERGROUND A.C. UNIT COLL AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS(ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM ' GRADING CIL yd, = PIUs XS of LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUNO FINISH GRADING FINAL INSPECTION CERT. OCC. GP/JCG FINAL INBPEGTQRS SttiNATYNE311N111A1b GARDEN WALL FINAL