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0010-034 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm Linder penalty of perjury that I am licensed under provisions of Chapter 9. (commencing with Section 7000) of Division 3 of the Business and Orofessionals Code, and my License is in full force and effect. License # q Lic. Class Exp. Date ' r Date �" �Signature of Contractor/�^' t 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). _ O I am exempt under Section • ' B&P.C. for this reason Date Signature of Owner 'WORKER'S COMPENSATION DECLARATIONr' I hereby affirm under penalty* of perjury one of the following declaration's: a ( ) I have.and will'maintain 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: 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 Policy No. STATE 001MP,1'03- F U (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 .1 should become subject to th workers' compensation'provisi �s of Section 3700 of the Labor Code, I h I f hwith comply with Bose pro ns:�'^�-�- p�,� } � ate: r ti!� Applican� Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties andoivil fines Lip 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 re resentatives of this City to.enter upon the above-mentioned property. `°r insction pure es._ VSignature (OwnerYiAgent) e_ `� - Daf.'' BUILDING PERMIT PERMITk r DATE VALUATION LOTTRACT f�� f ti'��9.�.2.'Si 11�" 2,61525� JOB SITE I i APN ADDRESS 47.054 VYA. QRVW1' OWNER CONTRACTOR/ ENt . S!CZMVV�?1•30kU7CJFYLJEVP•vll1YS' TIIIN1E3ERWI lORllDIEESTIG1N,CE-RJ/4!'ST.L.Vl�llo 8J:NT rlv50 ACOUITiRY MUD Dk 7 /�•56,I ACO)M-Y-RY,Cftyl3 g.tZ :SAA ��� x G� �2� F 1 1�Ai k�[ �k ��Et�"T 'CA X12211 (760)408-3495 0 PZ;N . 6133 USE OF PERMIT 3W.G E FAIA[€ Y 1Cf%MJ1_90 SFV,WT I'M P14€a3+f 2A>X . PE.P.A .IT DO&S NO1, INC1 ODI BLOC K DRIVEWAY - TRACT C NOTRUCnON 'rA40(� Oft Sri } PORCH/PATH.) i dd.©fi S 0_ARAa1FJ(,'k F'O.RT (SV) , 10, 34,00 G '; Ei 1 MATYM e:OSM OF (100ll Gwc41:`T1;UC a 10111; '101 1000-4.18.'000 `r O 0.00 PI.AH K kiBq X ,FZZ $661.55 l+liECH,61N(C.d�. PER 101-000-421.000 $40.00' k�..k',.tplf:�°,C�'dC�1,�� � ' li?1-��M'?ti•••t�r?©-f}11i3 �tEx'if.3dr r-„ P'IstF.Yw!�1�i L� Y C 401.000.419.000 81609 STR000 M17TI00 FEE - P. IQ 101.000-241-000 $14.26 FS'Y :�3-t1Qt1 20.0tz "lin3CTVWIMPACT Frig �t,S3�7%faf) "AID T TOTAL P.�WIPPOS DUE NC3@14'' RECEIPT DATE f f BY' n 5 . bATE FINALED INSPECTOR relCC) iY', INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backsy/J� Forms & Footings / _Z_�l• Underground Ducts Ducts Slab Grade Z ,L/ _ Return Air Steel Combustion Air Roof Deck O.K. to Wrap Framing l— 2iC� Exhaust Fans F.A.U. Insulation Z�/Z Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall _ Exterior Lath Drywall - Int. Lath Final. BLOCKWQ _L .,APPgiROVALS Final POOLS SPAS Steel Set Backs Electric Bond Footings Main Drain - Bond Beam Approval to Cover - Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Waste Lines Gas Test Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection / '� Pool Cover Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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. wU Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) ' . � - �Feiro Engineering,•Inc: ' •. . Civil Engineering- Land Surveying P. O. Box 12980 , ~T. Palm Desert, Ca. 92255 (760) 346-8015 FAX (760),346-2548 u Oct. 18, 2000 ti , • . 1 '_ . - l �,•- w� Y.,-.- i ' ,.r 1�. , •` � Irl' • - , City of LaQuinta - 78-4.95 CalleTampico, . La Quinta, Ca..52253 ATTN:. Building. Et Safety _ ;, ' RE: Lot 174 ` Tr. 26152 • APN:643-160-048 This letter will serve to state that we• have fiel&checked the pad elevation for the above project and found them to be as follows: ` Hikh: Low: _ Plan: , Pad = , 62.1 62.0 62.0 < Sincerely, ®¢ E S SO® VV' ?ames D. Feiro; - ®�� a' Vice President C5 >rVI No. C-24176 -RCE-24176 - EXP- 12131/oi J9P CIVIC. F OF C NO