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0107-215 (BLCK)N CO LU Q W G Z �D O- O H CO Ljj r` F_a CO Z cr) L0 N O� UQ 2 Z Ln CC a 0 0 J J maU tl C5 u LO H �Z C :5 1-_o \1 sir 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 and effect. Ltense # Lic. Class Exp. Date 11 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 isnot 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 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 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). ( ) I certify that in the performance of the work for which this permit'is issued, I shall. not employ any person in any rn , per so ns to become subject to the workers' compensation laws of Califomiia, and agr that if I should ome subject to the workers' compensation provisions of Section 3700 of th Labor Code, I si 11 foifh1ith comply,With those provI'sions. Date: Applicant Warning: Failure to secure Woftr9!,C.=pensa1Td coverage is unl8wful and sri"a1TsuuJect 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 of such permit, or cessation of work for 180 days will subject permit to cancellation. l 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-mentionedproperty^for inspect pu oses. Signature (Owner/Agent). ' G✓ Date f L PUILDING PERMIT PERMIT DATE VALUATION LOT (}��T_.', TRACT JOB SITE APN ADDRESS V.)-.1 4-9 HKATHERGUERV OWNER CONTRACTOR/DESIGNER/ENGINEER LA, Q1TIArrA.ORC:EI.rti.F? D PARTNERS 7 9-295 IAMBO LA QVIN'M DR, LA Q111MA CA 9-2251- USE OF PERMIT GMTEPLAL 6130JAY • 6' OR(* OARDIN BWCI( WALL 6 i1'. 'WALL. 79-295 RltANCTIO IA QUTITTA DR: 1.A QLTWA. CA 922.13 (760)771.1941 CIBUt 2996 611110100 Lir 1IRRMU VER Sea&MAVY COI3MIUCTI02 MIX 101.OfA.-A18.000 $162,00 L1'C LA074 AM PLAN' a'.i.iECK $162.00 J U L 2 0 2001WEEN DUN NOW U62100 pmirrf CITY01' LA OUINTA FINP,`NCE DEUT RECEIPT DATE}•{/!� �.! IBY D�E�I�Jq�Epo ^ (INSPECTOR 'INSPECTICIN REC©RD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR HUS LDWG APPROVALS MECHAN9 CAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans Q.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 H LOCKWALlL APPROVALS POOLS o SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final — 0 Gas Piping PLWASWG 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) ELECTfflCAIL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F. 1. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: