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0010-038 (SFD)4j, u LICENSED CONTRACTOR -DECLARATION I hereby affirm under penalty of perjurythatluam 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' vDate Signature of Contractorf 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 a,A contractors to construct the project (Sec. 7044''&siness & Professionals Code)., �. O I am exempt under Section B&P.C. for this.reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I he affirm under penajty, 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: (�)d 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 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 Califorpka, and agree that if I should become subject to the orkers' �compensatio provisions of Sectio 3 0 of'the Labor Co"de; I halj f • rt}� ith comply with tlfos� r° rs'on� 4a-7 f�4 J _ Applicant f% t z Warning: Failure to secure Workers' Compensation -coverage is unlawful and shall*subject an employer to criminal penalties and civil fines up'to $100,000, in addition to the cost of compensation; damages as provided for in Section 3706 of the Labor Code, interest and attorney's' fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and. restrictions set. forth on _ his application. 1. Each.person upon whose behalf this application is made &'each. persomlatg. whose request and for whose benefit work is.performed under or pursuant tO' any permit issued as a result of this applicaton Agrees -to, & shall,.indemnify & hold harmless. the City of La Quinta; its officers, agents and employees: 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date oflipsuan6e of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the 'above information is correct. I agree to comply with all City, and State laws relating•to the building construction, and hereby authorize representatives of this City to enter upon th/e'above-mentioned propert ell ection purpo s /Signature (Owner/Agent) BUILDING PERMIT PERMIT# DATE i VALUATION LOT TRACT JOB SITE Y APN ADDRESS 47-135 VIA ORVIO ID 643-160-052 OWNER CONTRACTOR/DESIGNER/EN INEER Iti)�e�i'�riVe'�"�,`�`-��.��'D:ill"i���:t'��;�1�1•.,U��t��.`3". i �d�isvi�`�i't�i;��-w�fC31JTt•$'�4I�`�:� ��:" i3��►''T!° 77�564 A, COU MY CiAM:[?Zo P7»564 AMTNMY CLUB Mt Palm DF-',SER.T' CA 92211 PA114 DEMRT CA 92211 USE°yOF PERMIT 3:Wfl3.F..'!'. F.Aajsi 11 :k1 y i RT -U G . MoLOT 111VI AN 2A - PERMIT WNfS 14af INCLUDE BbOCK; 471?'#'iUR001AWA PPROACH bRIV1MAY - i$1X. R. DUCV0N FOR M£ULTtPA�V, P7a:4 Mr..t` ISSUANCE OF SAMP, P AW TYPE, TRACT COJM'1PRUC'bION 2,440.04 3F , PMICH./PATM 126.00 SF CAIRAMICARPORT C3F) : tW,194,09 X& 1rr.T COST 0111 colghlorfl 7't,'°l°� S ).4115' 0) ���••��g,�7ryyy,��,pp TT`` yy6gyy !ta yg ,,p•p �ffi""3�a�S:S:[ jt ,YJ~G7ir [bgl.iYRai:4�.40.y . collo"':I` Uc x`101 no,, '101--0004 MOOtD 7g®.4t4► , PL A14 CHECK FU MPD1C1W41C.AL FU 101-000-421.000 r p1,UD 'ij1 q'•J{`61 !\J ^°I�OV^, :✓rVil47 Y2 9,J� STR[3NO Alit? FICC SEE . REBID 101-000-24-1-000 $:14.215 C Ra�,FaltiC3 ff1;1 161-000-423,000 $�t1.AtD DI~VIWPER IMPACT M -FA 'b9,gCfAtlti SUB-TMAL Lt'9MIRUC'r3.ON AWD PLAN <_10 ,C a ,E�rS o mv.ppm Fr,.Vs ASD g2f# Ss'0.00 DUE HOW 2000:. ' $3,2WA5 ` 10 , Ur ' RECEIPT DATE ' ` k 'BY +, t . ' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _ _ _ _ Underground Ducts Ducts Slab Grade _ �W _ _ _ Return Air Steel _ Combustion Air Roof DeckZ Z ©p Exhaust Fans O.K. to Wrap �_ / 7—p/ �� F.A.U. Framing f��/ Compressor Insulation Z—Zrp J 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 4j — /�� i SPAS BLOCKWAI,L .00L - _APPROVALS 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 Gas Test _ �-� Electric Final Waste Lines jZ�� / Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral % _ /_//) �V _ �j Pool Cover Sewer Connection / v 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. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) MOUNTAIN 911%111'ARCHITECTURE ARCHITECTURE & ENGINEERING BI6 BEAR'CITY AIRPORT 5UITE A-1 NO. 50X:5157 • BIG BEAR LAKE, CA 92315 (909) 58545311 1/24/00 City of La Quinta Department of Building and Safety. PO Boa 1504 La Quinta CA 92253-1504 RE: Lot 178, Lake La Quinta Plan #2 This letter will indicate that a structural observation has been performed on the above referenced residence by myself, or under my direction, and that the building is in conformance with the approved plans and engineering. If you have any questions, please call. c rely,. O TAI ARCHITECTURE.. Afji- Jo ..: F. Acosta, AIA �GL�SSD Ch<6 Lic used Architect JOHN F. ACOSTA,111 A.I.A. NO. C?4055 y1� REN. 4.80.01 Y Feiro Engineering, ,Inc. Civil Engineering- Land Surveying • P.O. Box 12980 Palm Desert; Ca. 92255 ` (760) 346-8015 -. FAX (760) 346-2548 Oct. §,,2000. _ City 'of La Quinta 78-495 Calle Tampico , La Quinta, Ca. 92253 ATTN: Building Er. Safety qr. I RE: • Lot 1.78 Tr. 26152 S' .Vl� .1/l E s APN: 643-160-052 ,� 7•. �- ? I . This letter willserve to state that we have field checked the. pad elevation•for the above project and found them to be as follows: High•- Low: - Pad .,60.7. " 60.7 . 60.7 N . ` Sincerely, \ Of ESS/ mes D. Feiro, �+ Vice President w N& C•24176 rn . i2 airoi i RCE -24176 s4 >' CiVIL F �F CAL>� .,