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0108-130 (PLBG)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`# 0, Lic. Class Exp. Date 1461$ Date °� J �, ` ! Signature of Contractor OWN ER-BUILDER-D'ECURATION rTM wrt I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 1, 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). as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). O !.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. (. I have and will maintain workers' compensation insurance, as required by Stiction 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: Carter 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 r k 1 Applicant Warning. Failure to secure W5-6eers'"�CUmpensation 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 F whose request and foe 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 inspe tion purposes. Signature (Owner/Agent) r ,*-' 4 -- Date = f t ANII�,DING PERMIT PERMIT# DATE `VALUATION LOT TRACT V 1.1 moo JOB SITE` ADDRESS s' APN OWNER CONTRACTOR/ DESIGNER/ ENGINEER 79-- m -Tcwipjf Zile mmE. E1,1035 MDAWN MD, D 10, CA 92201 1A QTI'KIiJ{tt. ,x A7.0 DES _ T -CA 92261 7600j346,2793 L.t.W 342 USE OF PERMIT �� .58,P IC ASANVOWYNT. SEWS W30K-UP VALUATION W .r X Cf 03; 09C-'O�S''�"T`��'f�.�'3:;�5. N '7y �/p.�'y yy'��y�p� � ��,'Sg'd';k�IA t�J�I,IMOD10 FEE _ "Sh"WER 101-000-419.000 DOM • t; AUG 13 2002 rramy FrEs uuE Now $30,00 CITY OF LA QUINTA , FINANCE DEPT.. RECEIPT DATE BY: DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Undergrcund 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 Final I I 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 p / c Sewer Connection / /� Pool Cover 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: _ :.rKt!=-''�ifp91�Yt'..i'n'+"vo- z'Y'•.--"k`'- '-'Yi'!:4'�Y •'k+ r°' .�"' . Plans resubmitted opy to: l_Q Cash Check sY r7 r. COACHELLA VALLEY WATER DISTRICT' Subcontactor List Order Called Contact Person CASH RECEIPT DETAIL; Grant Deed j r - .. ` 8 Recelved Froin • tzk Z ice' b - Date - — - X�C�/— Planning Approval Address: ' CUM n ^ Q Account No.' -`SO t� V School Fees Service Address •.' ` L . • G.A. Code .' . ❑ Meter(s) $ ❑ Service(s) .` y ❑ Backflow(s) O House Lateral(s) O DetectorCheck(s) ' ❑. Meter Surcharge. 1440nitation Capacity Charge ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee -' ❑ Plan Check Fees Water I Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other Remarks: IVT- ,'�[1� . Plans resubmitted opy to: l_Q Cash Check sY r7 Money Subcontactor List Order Called Contact Person TOTAL Waller Service Cashier CVWD-438 (11189) Construction �tcc3anical Electrical Plumbing S.NI.I. Gracing Developer Impact Fee A.I.B. P. Tota! Permit Fees Flood plain plan Plans resubmitted Grading plan 2i' Review. ready for corrections/issue Subcontactor List Called Contact Person Grant Deed Plans picked up H.O.A. Approval Plans resubmitted IN HOUSE:. 3' Review, ready for corrections/issue Planning Approval Called Contact Person Pub. Wks. Appr �D.teofsue School Fees TOTAL Waller Service Cashier CVWD-438 (11189) Construction �tcc3anical Electrical Plumbing S.NI.I. Gracing Developer Impact Fee A.I.B. P. Tota! Permit Fees EC SEWER, SERVICE- INC. JOB MORE ORDER dba ECONO SEWER SERVICES P.O. BOX 192 • PALM.DESERT, CA 92261 14999 nsn► AAA_27a_q 17AM �2A_77lan FAX (760) 347-4978 s DATE OF ORDER _ je SERVICE CODE PHONE . TECHNICIAN ,. HELPER STARTING DATE " BILL T9V- TYPE OF- 4n, ❑ CLEAN DRAINS ❑ OTHER ADD SS ❑ SEPTIC TANK ❑ GREASE,TRAP CITY WORK ORDERED BY•' ❑ SEEPAGE PIT JOB NAME AND LOCATION ADDITIONAL WORK NEEDED: TANK SIZE: , PAYMENT TERMS NET 10 DAYS FROM DATE OF SERVICE 11/2% PER MONTH CHARGE AFTER 30 DAYS. R DESCRIPTION OF WORK: CONDITION OF TANK BEFORE SERVICE _ Good _ Trash & Garbage , Excessive soap Fair _ Overflowing Sand _ Poor _ Blockage _'Repairs Needed _ Very Poor _ Odor Roots More frequent service needed Signature ❑ No one home ❑ Total amount due ❑ Total billing to for above work: or be mailed after I hereby acknowledge the satisfactory completion completion ' of the above described work. of work TOTAL PUMP DISPOSAL FEE TOTAL LABOR PLEASE PAY FROM THIS INVOICE. NO STATEMENT WILL BE MAILED. TOTAL MATERIALS DATE COMPLETED WORK ORDERED BY•' TOTAL AMOUNT $ Signature ❑ No one home ❑ Total amount due ❑ Total billing to for above work: or be mailed after I hereby acknowledge the satisfactory completion completion ' of the above described work. of work