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0208-245 (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 656128 C53 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 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. s(;f) 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 S"j'dATE C'OMPLKS"AT-1 Policy No. 046000610`911. (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 pro1isions of Sectio ion 3700 f the Labor Code, I srall, � rth ith comply with those24m/ A.. rs Date: 40 4 Applicant— .Warning: Failure Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspectiop,.purp6se�y' Signature (Owner/Agent)" `1'•' •- Date a 1 -t -OZ BUILDING" PERMIT PERMIT# 02OS-249 DATE �;' VALUATION LOT TRACT s�.(9,d3itip.(K? 47 ADDRESS �O- u(i Tff,0...F'F JOB SITE APN - - OWNER CONTRACTOR / DESIGNER / EN (NEER C D IR3�fxr� POO &.91, „�1 ei0 ' ���A? � 0, ; ��. L. '���+`����,//F��3`I.p���.�° 7014 AM? 01pp00 00 34 yy200 �9,,yy//..,,��yy �C4y6-1 rrAV':UB FTt�ICA 2 236 (760)'498••92Z2 WL9 oa 5 USE OF PERMIT POOLATWOR SPA Pt70USP.P►I88q A41 ARXftI.$.RR-1923 SHAn BF, 4N PL..ACr PRIOR TO POOL ANWOR S.P. , AND, IN ix MOWED COST OF CORY• MUCM i 0 20.0w.00 MIRM F VVE 90MMAR ai PLAN 0.11ECK FEZ 101.000.439.318 $1X53 CONSTRUCTION L;' �y,y,���qq,,{{♦9 �C�.(L�Df-pL�.�pC�'�.•�y1 in2�-bt�Ly► $20760 i�ij���i35N"WAM FEE -' F�44 : 101 •0 00x 421-000 SA,00 ELECTRICAL I'VE — POOH, x 01.000-420-000 PImUMBINO ME — POOL '101-000-419-000 t fi2'1,tii+ I AI IA 9.12002 Sus-iyyr'_A:1. !010, F � ..ANW'471.ml x S437.53 +... r" � RECEIPT AE BY �SPECTf �l/L_ Z ✓ 1 -t -OZ 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 Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS steel - Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Fi 2l Gas Piping - PLUMBING APPROVALS Gas Test Electric Final 'taste 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: f l etosty Lit f3ATN 3 - �,._._,'..�_ = t JOB ADDRESS Tul I Y ATH 4fk -, I� �__'� I PHONE OFFICE RES f .. � I .. LOT. TRACT PAGE BOOK Q, s LIBRARY � ` MAP BOOK PAGE NO. TC17 MAIL ADDRESS CASITAJ r ; CONSTRUCTION OFFICE PHONE NO. GUEST ROOM SCALE DATE DRAWN BY SOLD BY CHECKED BY 7_16 ©2 E, y - -_ 3 CAR GARAGE .. # Z 3 REVISIONS • DATE ,1 rn[: I n (ll 11MTa► JANDY UNDERGROUND ' f - PEBB. /PLAS MASONARY i + SIGNATURE DECK s - Dro;noge and Irrigation for planters and pots, by DRAINAGE NOTE: PRE-PE-BBLE others, unless otherwise noted. t