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0304-001 (RR)H N Cl) W O � � ti W c Z o. (D L) LUa� W. Z' ' L0 N aZ to erg. XW— m U U cl Q tiQ R 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. License # Lic. Class Exp. Date .Ss(TR7 6 0139 ,, �/; 01,3, LttZk. 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: ( .w) 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&RC. 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 consentto 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-9XAU_U1 W Policy No. ,- (This section need not be completed if the permit valuation is for $100.00 or less). I WWall certify that In the performance of the work for which this permit Is Issued, all 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 3700 gtf,the Labor Code, I shall forthwith comply with those prpPvisions.; Date: / j ` I k+%a�Warning: Failut_Q'�ppllcant_ to secure Workers' Compensation coverage is unlawful and shall subject an'employer to criminal penalties and civil fines up to $100,000, in addition to the cost,of compensation, damages as provided for In Section 3706 of the Labor Code, Interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made-& each person at whose request and for whose benefit work.is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Qulnta, Its officers, agents and employees. 2. Any permit Issued as a result of this application becomes null and Vold if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above Information is correct.] agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. / r Signature (Owner/Agent) ` } !� A L Date � . BUILDING PERMIT PERMIT# DATE + i ^� VALUATION LOT �# �'� TRACT ^ JOB SITE?, ADDRESS 4 _?0 VS fflH0%,W, _R JD.R..Tft APN OWNERr,� 4 yy CONTRACTOR / DESIGNER / EN (NEER PAIM, O a DAYW ROORNG 47.11 C > M.Irl]:iC1M? 1:)RSVE 47.445 kh�'.1�l,BOW-OAK.919R I-Ar"Un "A. 01A `1.125'3 'lEM17CULA CIA 925921 fv7hf}' 76.7815 MLA 'fig8 USE OF PERMIT RE -R OOF WI'i H GLASS 1A." 1i49.+$TER),ALS `i!.AJAIA:`i'Y014 7,11b9,(Io L3 ]EYD AI:i'.'IX 9 Cogr f0' t'.t3Nh"I".N'Ty'C1,701i 7.739.00 lPV,RKrf FEE �,'iiTXVVK4'R'Y' fftEFd<)OF PIE* 101-000-418-000 33tI,Afl + , APR 02 CITY f A� �y0. h'Sla 47.tl1�.l �C UCTIO J'11`M PLAN G1LGS..,t e� h fyfl LESS PAA -PAID k110 '1['CA'1A L+ FIf�ViPI'.1W'MtDUE NOW RECEIPT DATE B i' DATE FINAL D� C INSPECTO NSPECTOON RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR 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 Innes Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS P®®LS - SPAS Steel Set Backs Electric Band Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric r Underground Plbg. Test Final Gas Piping s 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 Seeder 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 Sa vice Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: T' Page No. of Pages DAVIS R00FIriG 51-075. Calle Paloma La. Quina,, CA 92253 (619) 564-0407 Lic. #530086 PROPOSAL WRYITTED TO > -Ole CA - PHONE - BATE ,STREET 1414-) JOB NAME i-e11S6A-Wo—t-o6;4- ciTY, STATE and zip 0Onr 7ZO JOB LOCATION ARCHITECT DATE OF'PLANS A. JOB PHONE We fropitiot hereby to furnish material and labor—complete in accordance with specifications below, for the sum of. SO4 All, 4L-0 ,-, ollars I Payment to rrm&9:ss-f6IIows-. Ali material Is guaranteed to be as spectilled-All work to be completed In a workmanlike manner according'to standard practices. Any alteration or deviation from specifications Authorized below Involving extra costs will be executed only upon Written orders and will become Signature an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control -Owner to carry fire, tornado and other Recessary Note: This proposal maybe v,, insurance. withdrawn by us If not accepted within days, We'fieaire6y Submit ip"cationsind estimates for: 0A) 17) 07A) OJQ�AD Zqj&4Q'j PLO f y 'GLA-I&S -t 614 7 16b A Dh AIC- A)1` -L 62k��'C, S.44 5e5iPi��- -CDA)0d&2%9= -44n (1) Arciepunce id t1rapas81—The above prices, specifications and 'You, L conditions are satisfactory and are hereby accepted. are authorized to do the work as specified. Payment: will be made,as outlined above. Signature I Date of Acceptance: Signature LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and WProfessionals Code, and my License is in full force and effect. M ch License # - Lic. Class Exp. Date Cy LO cZ r-- Date Signature of Contractor co 0 "� r— ~0 OWNER -BUILDER DECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ 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). ce) () I am exempt under Section , B&P.C. for this reason In N Date Signature of Owner ON Q) a< WORKER'S COMPENSATION DECLARATION < Q I hereby affirm under penalty of perjury one of the following declarations: n H p O 1 have and will maintain a certificateof consent to self -insure for workers' K W !L 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 V ( ) 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 H permit is issued. My workers' compensation insurance carrier & policy no. are: z Cartier ".1TATE!: F'U'P D Policy No. 1'!,`'O)JO-00 Cb -1 t` C) g (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 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his ■ application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta; its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE otezau+VALUATION � % !y.= .LOT TRACT JOB SITE ADDRESS 47-7.1.0i?;Ls�Pd�lt��+IfiR.Jt!rI�''1*� APN OWNER CONTRACTOR I DESIGNER / ENdIINEER PAUL W;fl.L' 4Z!,kii. DAWS XtCU3'1'1 140, 4'7-710 "MOT't+i.410WET. D1RTt► & 41,44 .5 Rr. Df_,'AU'Wc >> -�5 :� DR 111%. Q13WA C.A �?`r6 53 '1`A+��CiA"i:; L& clk f�:a:f:%• i7 l.f)676<781,$ CT -14 71119 USE OF PERMIT Cl?iAI.BE:7:LL:7ID.M V1 }ft1A,Ti4.)'i''1 iN `,.:(_XVA: 'tJi.• i. O.WVI RUCTIO.N 1' F:Ed>r YC''iE, MCF. XsRIAMARY �I:r."r.<�'.t"CB`�,hs!".(t:'�l�!�::"h.2r'!i„i�'�:�Er3'I;h7L�lyl'_:K.t�l (�.T•���.`.�. �',:��}.n(: RECEIPT DATE BY DATE FINALED INSPEC INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX 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 bid Final Final 3 1 BLOCKWALL APPROVALS steel POOLS - SPAS 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: