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9712-064 (SFD)LICENSED CONTRACTOR DECLARATION uj I hereby affirm under penalty of perjury that I am licensed under provisions of F— Chapter 9 (commencing with Section 7000) of Division 3, of the Business and N W Professionals Code, and my License is in full force and effect. O M License # Lic. Class Exp. Date LO 34� 12131!97 Z C) /Date Signature of Contractor f ) C) O t` J U � CD OWNER -BUILDER DECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ CL License Law for the following reason: Z_ ' ( ) 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). <'`) () I am exempt under Section , B&P.C. for this reason • u� N Date Signature of Owner OC\1 Q WORKER'S COMPENSATION DECLARATION j < cr I hereby affirm under penalty of perjury one of the following declarations: HO (.) 1 have and will maintain a certificate of consent to self -insure for workers' { w � compensation, as provided for by Section 3700 of the Labor Code, for the � Q performance of the work for which this permit is issued. Q U (. ) I have and will maintain workers' compensation insurance, as required by j U Q Section 3700 of the Labor Code, for the performance of the work for which this L. 0) Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier Policy NO.. r- O S`Ciii'E 1"tIN43 626333-,97 J (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 I should become 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply withf those provisions. VEIate: lrte, t'"" �t Applicant L, 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 hi's 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. f r ./Signature (Owner/Agent) Date BUILDINGPERMIT PERMIT# °°NTR°`#. DATE VALUATION LOT 9712-064 TRACT s 5 1 .: i 49 $141;2413.30 6 28=1 7=2 JOB SITE APN ADDRESS 4 43-150 GENOA URT'V1♦ 609-fiW0.13- OWNER CONTRACTOR/DESIGNER/ENGINEER THE EXCI ANQH GROUP ROGER SNELLENBE.RGER. & ASSOC. PO BOX 13335 78665 NAPLFS D"RfVE, LA QUANTA. 92253 P.ALN 4 DESERT CA 92255 PALM DESERT CA 922.55 (760}'772.0,2'.2 CBL'# 1858 s USE OF PERMIT f i e .' 1 LOT 5, PLAN 5:1It ; 5W - PHRA T DOES NOT INCLIME RLOCI;, WALLS OR POOL, DEC 16 1997 r. 01 i i r' L1 QUiNTA TRACT CONSTRUCtION 2,4(H3.Oti 8, Y PO:RC'"ATIO 1450.130 Sr. GA.RAGWCARPORT 449.0% F ;> ESTOWNI'ED C(Wf OF t4ONSTltt7Ci ON 1.41;24 ,44) PERN11 T FEE SUMMARY CONSTRIX71ON FEE 101-000-419-000 $785.30 MAN CHECK FFA 10.E U00-139-318 U47.91 MECfi1AKIC AL Fh--k" 1 d 1-0430-4?,1-t3ti0 $00.00 FI. N.CTRICAL FEE- 10.1.000-4.20-000 3141.1413 PL1.IMB1140 FEF 101;000-419-(X30 $140.75 STRONG MOTION FEE - RESID 101-000-241-000 $1.4.12 GRA©3NQ FEE 101-000-423-000 $20.00 1:Pl RA.9TRUC1TU'Rh FEE •2125-000-443-342. ART Iii PUBLIC PI ACES - RESM 701-000-255-000 '6:133.12 SUB -TOTAL COAIS'1'RUCTION AND PLAN CHECK 55,0441.09 LESS PRE -PAID FEES 50,014 TOTM, PERMIT FEES DUE NOIVIEr 55,044,09 RECEIPT DATE BY( DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade - ao - Return Air Steel Combustion Air Roof Deck t Exhaust Fans O.K. to Wrap 3 F.A.U. Framing -�_ Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final ' , BLOCKWALL A PROVALS POOLS - SPAS steer Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection - Encapsulation Gas Piping Gas Test 6 -y.¢- Appliances Final Final Utility Notice (Gas) ELECTRICAL A PROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Futures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power -Final Utility Notice (Perm) ,$- COMMENTS: