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0212-006 (SFD)H N (n W ouch W 6Zr� CSO 0. I— ca r` �a In Z M LO N ON U °) It Z FZ cc O QJ J mQU Il 0) 0 Z_ ob / r, V 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 717699 B 0413012C .Signature of Contractorgy��i�• ^�^^- 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 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. (q) 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: Cartier IMERTY iUBilli'UAL Y. Policy No. 'W.f;:262D0047.�: 01211 (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: Applicant --2-- Z✓' /, 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, ini Filly & hold harmless the City of La Quinta, its officers, agents and emp es. 2. Any permit issued as a result of this application becomes null an work is not commenced within 180 days from date of issuance ch permit, or cessation of work for 180 days will subject permit to cantLU I certify that I have read this application and state that the above infor correct. I agree to comply with all City, and State laws relating to the construction, and hereby authorize representatives of this City to entthe above-mentioned property for inspection purposes. ignature (Owner/Agent)f�^�----^ Date CII F BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT Z24JOB SITE _- ADDRESS 1 i D �.'E APN 7'r",tOWNER CONTRACTOR/DESIGNER/EN &NEER 73.1211�RED W AI�'WO �1ilii 73-121 :�+`.� LD�fA1�.1:.t�iCY0100 1),�..1ki ?.rawr C,A 92x60 PAL.�t( DES. •RT CA 92260 (760)6'74.9693 C.C" 38,42 USE OF PERMITLOT 169, 7�1?iCP� J,IO i f Z+:. A P ±1 N11T DOES 1'400 fNC L UDX Z.LOCK 1i�,�.YX% P(XX, A7i�A. CIA, DMV W A APPt OAS CHCUSTO�k C:�3Ai3PI�tJG,yoN3,11?4,00 3F PORMY'PATIO N61:00 SF 41A1E'i.!\�" '' CARPORT 3"169 OF ES11K 6'y FD C�.taS� OF t�'�'?l��•.C3�;►C'.r1�, N 324ol,93.70 1'E�' &. � t: YRR SFi�r�flARY ix.)NOTRUC #'101 Fi'E 101��Q00A.18-000 %1,5:x?,00 PLAN CHPIC-'1 t�f; 111-000-4:�9-118 31,156.03 WIRC1 1C 1 FRE 101.000 421.000 �1�OM ZLW, , !-R1b,AL 17:1: 1U1 -00t'1_420-000 �r206.50 PlIUMB1110 FEE 101.000,.119.000 $190,00 ITR NI Q d�c?7"1Ci•A1 1, . HUSIL) 1til -000-241-000 93.x.43 Coir' lD:S140 FRE . 101.000.42.3.000 WINx)f?'if'�:1.�5#�ER 1Q�P.�1CT ifi e $2,+105.©0 :A1i r 19 Pf, BLIC 1�i�A.C...5 . RNSIE 7,70-OW44s­,000 $3l.0,465�.► b..T01 AL. C0.i9'�'%�.1,Ji�'14 D14 ALM :C�.l:.�� C� TMK $5,8 y.3.59 /��y yr•a.6J. AI, P,.f�•PS-L+D.1�SYS RE DI :C7';}YYC 17 2002 OF LA QUINTA INANCE DEPT.RECEIPT DATE BY E INSI P I , u 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 ,1 .o 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 .=. C, 3 Drywall - Int. Lath .� •O'3 Final Final t1 o - BLOC�KWALL A PROVALS POOLS - SPAS steel SeLBacks Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPR VALS Waste Lines —j� Gas Test Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection _ _ Q3 _ — Encapsulation Gas Piping Gas Test2 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: 1 v v v — — , � —..