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0105-033 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under"penalty of perjury that I am, licensed under provisions of Chapter,9 (commending with Section 7000) of Dlvision 3'of the Business and rProfessionals Code, and my License is in full force and effect. ' License # Lic. Class Er Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that] am exeempt,f6im the Contractor's License Law for the following reason: (,Y) 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 DECLARATION I hereby. affirm under penalty of perjury one of the .following declarations: () I have and1will 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. 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: Carver Policy No., t�i�Fvk' 4 •. (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- hat if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,,,Lshall forthwith comply with those provisions. Warning: Failure to secure Workers' Compensatil shall subject an employer to criminal penalties and addition to the cost of compensation, damage"s of the Labor -Code, interest and attorney's,Ws.- ,erage-iOunlawful and nes up�to $100,000, in ed for in Section 3706 IMPORTANT Application is herebymade 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-mentioned property for inspection purposes. Signature (Owner/Agent)f �'� Date PERMT# BUILDING .PERMIT r, DATE a VALUATION ! LOT 01064)33_ TRACT JOB SITE APN ADDRESS ag 420 AA OWNER CONTRACTOR/DESIGNER/EN INEER L}ZORAW0 1AM . : )NAM LAM 17.0, BOX 4;10 3 („fit 119 ,• . 1A C;j!U1Nft' X CA 92233 PAW Si3)F'sw t✓.A. 92260 � 6Ci)3 bm§►£�S CoLlf. 6471x: USE OF PERMIT StfPP YML*1-AL TO PEW= 0010-n6 C'H'.A'NOV OP COATJtAO`f OR X1111YAWWO MST OF COMFIRTICIMN 01M riF�� T 3, A?S� l�` FAL, IfDi« i3��R 3 lSJ+1 $4,50 °!:L).'�4'.�L`�"l:: P EMM. Da � ► PRE-RAIDI US �4e4f. ..O�RwS9Y YOU'S ,n.I't E 1109 M AY - 3 2001 1) h K I CITY OF LA OUINTA - RECEI : H. DATE FINALED INSPECTOR r INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR r 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 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 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 Pool Cover Sewer Connection 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: - 'CITY JOB ADDRESS -- ;'Vl `-1 OF PERMIT NUMBER LA QUINTA-SUB CONTRACTOR.LIST L- I! LEWAkDl �/V Z r' % OWNER -� MILDER " 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 applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. ontcor.:., r....... onractor. s.. cense; ...;..,:....:CtU..:,::::::•:::.::::::.:.:::.:::::>::•::,:. tonsurance.Cao ..:.:.::.:::.:..rkers::Com ensan:I..;:;;:.:.;;.:.;:.::•:.;::::::.;. ;• CiY :Business Licensess�ticaio Company Name sification License Number EzP. Date Carrier Name � PolicYNum er Eri .Date Li cense N umber Exp. .DateCla ' (e.g. A B C-8 1 9 xx 1 x xx/ x xx / 1 1 (e.g..State Fund Ca e. ICom 1 1 9 _ P 1 Format Varies 1 xic xx 1 / / 1 xxxx 1 1 xx x x x x 1 / / 1 THWo K`C=12'.. RT..R..:.1.:.:,.::.:�:.; f Q sr Levn rGL- L - 7 9 7-'2, Z'6 3 3t p 3, X �. - �` (o (o gI2Zl0 3' ��-�, v7� cryC�s Z loa . FRAM NG IC a iL S 3=31-03 WA 1 VeDt P�A ti, A .o 3 z z oL ;ST..... MASONRY IC 291 L£�n//�� LA�t A l VCS n/� �/ . • PLUMBING (C 36)-��ye_ - �C�j(YJ/NQ �L•r(IYI i - ".41C, = �- _alp_ J----_ /f�(oy _ ijGs/ -A.T. IS.TERAC. 3 :? ' L�N�IZ17 LiSJ�) WA i V ED. a N q 1C! 9L LlVAPT� Awl g 7 ten. r.,/' o� Vv/� l VC l� N q. do N/�� •�I: HVAC IC 20iXly L-A l�(lN A �' CoN�I (�iW� V C - 20 • - 3 2 ! b, . S %I TE G cA/. S . Z Z Zo� =dy 01 - ELECTRIC: L.IC;.:,Q.1.. M e% �i L C= p I ASO r: ►o.�3F ,O /DA l /�, � /0 ROOF. GIC -39) - /�6,(/ Yl/ �j -, 2 �7 t z !�zr/0�i �, '� l (/C� w�/� 'V/%� '4EET<METAL'' C 431 `:.....::: 1. - • FLOO ANG IC 1 !S .-ivc��e F�afz c6vz-�� T -00T i C -r � .� , ... > � � � : �1,� 0 -2- T,;.. �� 5 �OG 8q�l�l �5 �l�l��S A/C C-17 ! �° 'fPti Tc-wD . l ��f �zd� 6 l D o�li !y� v1 D% _ INSULAT . N..I.G=21' > s''<:` /}� �O/V Sic 1. �oN G- Z ��iL b7 ti 1. �, �: x'i /LO G / 3 _ .. / �� . O SEWAGE?;DISP,.: «..:. 2� O;r CJ N . PAz P�u�ne�ti - 3 - `iso �s '73/ S O � /D i oma- � 9 D Pl1C 3)....:...: .:: 6fK[LAM 7-14110( W,4 VC- -iv/ t �✓/� CERAMICTILE'iC=54 '>:;::<. at 16 IV14, CABfNET...;:IG-B� C�-BIIvL- I 'lj�. _ ._ C-� ,7��2��. c► r,l'l � .��� F�'��-t�C Zoyr� �n/�CN►o�`�1�=�1 • 6.17 / / ��I, �ob�: �iNoI FENC...::....:�r:�:.�:31 LLb /f/�K� %�1"DV1 �j _ 7 / ?�2✓jam r ��% I I , . V�T� �>/l� � h-.//} Co LANDSCAPING; IC=271>•`>>. i I 1 ' P oL.ic - c (ol c�Za1$ � y�-30-03 d( 15�710�3.1 - -0 q "19l "7 4� 8 v 2 s CITY F QUINTA 3FCFMOFo�S BUI,©') & F DEPARTMENT 7 -7 , INSPpi,.,T T LINE ` i; 7 -71 r Owner \ LEON Contractor, i ' Permit Nu�0105-033 POST IN CONSPICUOUS PLACE INSPECTO ST SIGN ALL APPLICABLE SPACES JOB ADDRESS 53-610 AVENIDA VILLA ` SUPPLEMENTAL TO PERMIT 0010-276 CHANGE OF CONTRACTOR . TYPE OF INSPECTION DATE INSP. FOUNDATION &'SETBACK FOOTING STEEL MAIN GROUND SYSTEM ` GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED CONCRETE SLAB = JOISTS & GIRDERS' ELECTRICAL GROUND WORK ' DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC - ROUGH PLUMBING ° - ROUGH GAS & GAS TEST HEATING & VENT -A/C FIREPLACE ROOF BOND BEAM O.K. TO WRAP_ t GROUT `❑ 4' ❑ 8' J r +1r FRAMING INSULATION. •�at�`,,r�t , PRE -ROOF r" rs Y . x.•y�`ka.» COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED:'t*�"� H` t d t 1� a 1,7491 •rid * r+fir M• DRYWALL INTERIORMg EXTERIOR LATH r n POOL PRE PLASTER = � °fir t'} i — )�, kmi I x POOL FENCE &GATE;;z',7 j( Y%SEWER SEPTIC TANK .izHv��i ri 341kr. �, FINALS 'K •ELECTRICAL 6 2 O `°PLUMBING f ' FINALGAS TEST HEATING -A/C x l T I+ 4O.USE NUMBERS ;LOB COMPLETED �^ ,jEMP`POWER wY���f:-�ir''3,r"' %� 'x � � CK � ec r =atI 'I A - ''� • � _ f i+p ABOVE APPROVALS DO NOT INCLUDE RIGHT TO ¢ j rt - yY:TURN ON UTILITIES OR OCCUPY BUILDING" `