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9607-076 (RR)U) F_ U) CNJ W Z) C,) C) Lo r W r- Cc Z 0 (0 �Z CY) _J (.) - W W CL U) Z (Y) LO C\J 0 C\J 0 a) IL < 2 Z 0 Ir Lo < , FZ 0 X W Y= 0 _J _J ca _J < d C) qt Z C 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 alhd effect. License # Lic. Class Exp. Date /7 Date Signature of Contractor—AZ OWNER -BUILDER DECLARATION 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason Date ik- 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 formorkers! compensation, as provided for by Section 3700 of t ' he Labor Code,,for the performance of the work for which this permit is issued. :. I I ( ) lhaveandwill maintain workers' compensation insurance, as required by S'Ktion 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:$1 00.00 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 370O.of the, Labor Code, I shall forthwith comply with thos%,provisions. Date: 2- Applicant._-­�,;' Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to'$1 00,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Ap�lication is hereby made'to the Director of Building and.Safe'ty 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 appli6ton agrees to, & shall, indemnify & hold harmlbss the City of La Qui;ta, its officers, agents and employees. 2. Any permit is�ued as a result of this application becomes null and Yoid'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 h6reby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) -Z `4-W'1111 Date !j - PERMIT# - ' CONTROL# BUILDING PERMIT 960-076 3746 DATE VALUATION LOT TRACT JOB SITE ADDRESS 49-98106V,941 "LLE ESTRELLA APN OWNER CONTRACTOR / DESIGNER ENGINEER S AN" r, P, R 0 SA. C � 0 V EAHA. 0'. A� WEMERN PACTIFIC "R100FING 50-407 CALLE 0ANALA W2 LA CAMPANA VAY V JA QUUWA. CA 9ZI53 PALM SPRINGS CA 92260 C.MW USE OF PERMIT 02WERAL BUILDING TUL�ROOFIPO. LYUR17134ANL FOAM VALUAT-ON EST tMAWD C0.51"OF CON.STRUM [ON PERMITFIKE, SUNMARV SUD,TCYCAL CONWRUCriON MD PLAN CIMCK M-00 LESS PRE-111AID PRES IS 0. 0 0 rAL PICRAUT -FE kS"OUEWOW $30,im JUL 2 3 1996 Z By RECEIPT 1BY DATEFINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS SetBacks Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck ExhaustFans O.K to Wrap F.A.U. Framin§ Compressor Insulation Vents Firepla P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL'APPROV LS Steel POOLS -SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground El ric 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 UU14 Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior* Re;cieptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: