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0110-256 (PLBG)61 r,'nals CICENSED CONTRACTOR DECLARATION under penalty of perjury that I am licensed under provisions of mencing with Section 7000) of Division 3 of the Business and ode, and my License is in full force and effect. Lic. Class f Exp. Date Date Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: fi() .l, 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). , () I am exempt under Section , B&P.C. for this reason r Date i✓/ ?.s%irU•' Signature of Owner "`✓ - > _._____. �' - �� -_-__`...._,_.........,.ems: -..- -- '-'•-�'6:..f.W� .. RKER'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 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). $() 1 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 3706'of the Labor Code, I shall forthwith comply with those provisions. d ✓ Date:,/. /T Applicant �+' I , 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 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 cf 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'ins!lpection purposes'. Signature (Owner/Agent)�'n �/ •'% =-^ . /-*" Date'��!' /ifs' BUILDING PERMIT PERM;, DATE �/ VALUATIONAI 5mow LOT TRACT JOB SIi E: ADDRESS Fa-7�aid>�xa°: APN OWNER CONTRACTOR/DESIGNER/EN INEER LLAT NQU114TA. CA QN 5.3i USE PERMIT (O�F W Yf43-Tdt;,YJ,A,_TIC;N 0 E�tKiff GAS LINE ONLY ;KAZ C0N''NWJ.'10N O )diJ'f'URP,' .t PPR( fED APPLIA130-;01, r ' VAVOATION Ls NI MI./ TM) C051T OF (710NITYR 5CMIPIOI`I 14M.00 Muff rt HE WMMARY . PLrIl.NW.40M 101-00 0-419-000, D° �0 OCT, 2 3 2001 Q±I�YOFLAQUINTA FINAN , DER lii: IVI.VICA.i CONS'1 R%C r)0.9 AM PTAX CHia;`K $15:75 IRM PRE, -TI ,ED FM S0.00 NOW $18.75 RECEIPT DATE BY DATE.FINALED INSPECTOR INSPECTION RECORD kF "•.:Lia OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR - BUILDING APPROVALS PPF,r:ms MECHANICAL APPROVALS Backs Underground Ducts &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 Lah Drywall - Int', Lath 4 Final Final POOLS - SPAS BLOCKWALL 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 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 t COMMENTS: Final Utility Notice (Gas) ( 'l ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtotes Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) kF "•.:Lia Jul-25-08 11-47 From -WATER DISTRICT/COACWELLA VALLEY 47603993711 COACHELLA VA LEY WATER CISTRICT CASH R1 CEIP`T DETAIL Received From:-7—q'•'`�-y��7 Address: ._ r/ 1 f 7 �� ; `� C% 421 Account rvo- .._� Lot(s) .i 5erylee Address L Moter(s) L SoNlce(s) „ p�ckflour(a) _ G DetectorCneck(s) i —_ MeeterSurcharga UA1.1-itabonCapacity Cnarge ❑ W.5.9.F.C. C' Twmporwry Construction Meter 11 Turn on Char -go ' +J Uncollected ACCount - Name ❑ Inspection Fee - Tract Fee - Plan Check Fees Wator ! Sewer - Tract- rJ ©ond Payment - A.Q, -- —aond Asgmt. ❑ Customer 17epoalt 0 Other Remarks: i - 10: U f! } qjAPY •�.+ Cash Check . f Money Order T-662 P.04 F-882 E TOTAL. S . . Water Service _ Caahier_-� �^ GVWCJ-aaa riiraet C, Received 07-25-2008 II:4eam From-+7603983711 Ta-CVWD PO SATELLITE Paire 004