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0210-172 (RPL)LICENSED CONTRACTOR DE�"I.ARATION I hereby affirm under penalty of perjury that I am- .-nsed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full f ks and effect. Licenser# Lic.�gClass ' Exp. D�avt/e. p+�q VJ.nl Y04 Date Signature of Contractor a� ak x.W 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). ( ) ` 1, AS 6Wh6F at ,tw property,' am exclusively contracting with Ilcensod 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 17, 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 wil'I'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 c)?'A'TF' RIND Policy No. MY744-92 a (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' compe,nsatibn rovisions of,Section 3700 of the Labor Ir Code, I sh II forthwith comply with tho provisions �+�-�, f Date: liJ 7d Appli&araL— 1�L"......:...W- Warning: Failure to secure Workeil 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- mention fob inspection purposes. f '. . Signature (gwnel!Agent) Dat ` BUILDING PERMIT PERM T# DATE VALUAT16N e�'w LOT ' TRACT JOB SITE{ �r ADDRESS 73.1146 ZENTal INAY APN OWNER CONTRACTOR / DESIGNER / EN PER DAV,UNRY All,.lIt:'�L t�1�7 P0alI L�'0.#k A.08 78.860 MMIT-1 i3UAY. PO BID IL 311 R1sDL141103.9231J3 LAQF.T rA cA 92253 MUM= CIA V2,379 (909)798«7242 CUA 6132 USE OF PERMIT P00U.;PA. A1,!'.TcIUf5:r1 Al PJV.S .oHA LL BIZ I've) PLACE AT PR P'LA'; zP PrOOL ARCtOR SPA 24,©0,02, .I!«`; E911Fs'9.A 31". COV OF S=ON Yt"",�RUC.'�" 011 24�W DX", t°,i2uT~1<"M iafUMMARY PLAIN Cl•1FCK 3i'�: 151-pSTt�«�3��31i3 $T 7. CONSTRMC':710141FEE $243.00 149CHANICAL FEE -• POOL, 10144000.421.000 01.05 C,urC.n.1cm, ne - pool, 10-000-420-0100 "$as,€ 0 PLUI!'3BINOFR. 3'Col, 101,000.419.000 00 r. �9J.3- t'T,Ai..0 i 7C1.1'(39ANTID •'Z.et'7ivi C: s—CR 96.35 p 1,03 PFX-p ,E .8 MOO OCT 1 2002 A. -,L 21MM ° M' SDUEHOW CITY OF LA QUiNTA $4.rjrm FINANCE DEPT. ; RECEIPT DATE 3 BY T e DATE FIN ED INSPECTOR 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 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Footings Electric Bond Main Drain y 3 Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. 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 Sewer Connection aas Piping Pool Cover Encapsulation Gigs Test Appliances Final COMMENTS: O S 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)