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0307-038 (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 300480 •fit ••2 ' � ? �Ir-r>.� Date �'�t'� t%'' Signature of Contractor•'•, ; r'"'`•' 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 Godo). ( ) 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. (4)-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 1 % "s , f r ••P EWUM 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,proyisions.7 / Date: ,.. Applicant r l t ..' ,.y; . �•,x .(�,, • s fT 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 fora 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 inspection purposes. Signature (Owner/Agent) ~` �••H'(` X6,11`"1.,'* -`Date ' PERMIT # BUILDING PERMIT DATE i j VALUATION LOT LOT TRACT JOB SIfE ADDRESS r _%_W9w1a"1 ) FOOT APN - OWNER CONTRACTOR /DESIGNER/ EN INEER )DOMY DAIMOX x � :l!.Lq. rn a�� S F� .S= , tt:.'L'r� D 44A ,quozmp. CA P)'IM4 WFUZ CA 92210 USE OF PERMIT d��_f +yG{i*G SPA, 2,10 i.. Yk}. Ly'.sly IV(!r�_t�?u,L, is �y.p (�` ' p 4 1 rtr_I� D1S1RI,b.Y'4/i. R&1l ri ?ARR1J',rfl�tJf ai t'�>aR.tlr t`i� dE`1 7 W2t.-s P..<1 %' iiti1�•P}.ii�..,��'f<:�. STAN ltv'nl?sC;,vow, F;Qu:i,t='w'i, r mi(".Id=5Lxt' hluT 1331C"tirJ w � 1U0rA1h114)A1KW1 BRA 14 El CONSrRl. CITZON ME S-O&i A, {2. vi MVCHNNICA1,PK -• F(DO1, 10).000421-.000 Sx4.lta 1f?LUt!TRII-A.L• FEE -• :POOL aiii.-i;t:,� F .��fi-�)�7� $4J.&; 47` .I '•.Gi�+.�.CILr '��.OZ.'V i."i :1'J..�'r..' ;S C`r ','��s•/,f„� ,1".wf 4v 1...[';{.::AM.f!. x':71 3.P-0 JUL-08,2003 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DAJE o _� BYE iy D4/, A E F IN E .r' —' ��S INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set'Sacks 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 Und -!Underground PI p Final Th —g PLUMBING APPROVA S/7 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 Sertier Connection Encapsulation nit Gas Piping Gas Test App;�ances Final Final UtilityNotice (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: _. --- .... ...,....vv .�., 11 ,t...•r 'K 'J, yl or•e. ti.Jr"CrllVll IVUIVICStI'S UWNI:K 1U1t,/�1/G. // /�C '..,�2+�L,) -BUILDER E /��P!•7%U�i JONS This form shall'be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each armlicable trade. all information rP.n11P_S1PrI hPlf)W mimt ho f-n—f 1-+-,4 h., Trade / Classification Contractor State Contractor's License " '" Workers Compensation Insurance City Business License Carrier Name Policy Number Exp. Date License Number Exp. Date Company Name Classification License Number Exp. Date (e.g. A, B, C-8) (xxxxxx) (xx�lxx/xx) (e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx) (xxxx) (xx/xx/xx) EARTHWORK (C -12)S G .' O(v - D)l:! lG� ,�_ Y 3'` S i.� r–cw -z) M c� ' - ' �,n - �, s 3 2C� ! 3 -7 --�-� CONCRETE (C-8) FRAMING (C-5) S £ L— �`7 1 '8 7 1114 - .51XFV04 STRUCT. STEEL (C 51) ry < ^�'i OU $ � 002 Ir? n G MASONRY (C-29) i Al PLUMBING (C-36) ko3�-o )0/? ;>. LATH, PLASTER (C-35) DRYWALL (C-9) HVAC (C-20)`. !I ELECTRICAL (C -10)o b3S�SO 01 3/ oA Sll(%i . �/ '00?�� of 0 ROOFING (C-39) SHEET METAL (C-43) • j FLOORING (C=15) GLAZING (C-17). 4 INSULATION (C-2) : f SEWAGE DISP. (C-42) PAINTING (C733) i CERAMIC TILE (C-54) CABINETS '(C-6) +. . FENCING (C-13). ; LANDSCAPING (C -27)-q POOL (C-53) f �` L� C -!2/C- i a oZ b ©�0 &J. i _ Z14] Rio �r N I FIREPLACE +72" DECK +12" ADD 36" BLOCK WALL TWO 6" — STEPS QUARTZITE' TOP CALIFORNIA — TRIM 1 L EQUIPMENT WALL 5' HI NEW GATE MATCH OPPOSITE SIDE SPA +18" WITH STACKED QUARTZITE SPILLWAY/ CAP .I \,18' -0" P/L 6'-6'� rn PLANTER +12" PLANTER DAVISON QUARTZITE CAP/ SIDES WATER FEATURE \ _ — 18" WIDE CASCADE \ 1811 WIDE CASCADE — +42„ +12 PLANTER \ QUARTZITE CAP/ SIDES P/L 1' - R A 14 — BB 3 6' R :� ` ,. ,It QUARTZITE +6" , TOP +6 +G„ _ POOL SIZE 37' X 13' _ '_ 7l-0„ R 5' DEEP 137 „ 3'6" EEP �- ADD 36" P/V\ +42" BLOCK WALL 12" OVER �— SKIMMER ` HANG AUTO FILL . s ^ UMBRELLA SLEEVE 01 PLANTER PLANTER -P/L 6,-0„ R . DECK TO BE CALIFORNIA GOLD QUARTZITE A� . -PLANTER . ,: JANDY RS 6 j / J i ALL QUARTZITE CALIFORNIA GOLD_ 1 PLANTER F LA 0 INTA !GS.SAF DEPT. , �p0 D STR C ION