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0308-003 (ELEC)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of l'— ' Chapter 9 (commencing with Section 7000) of Division 3 of the Business and (V LLLJ Professionals Code, and my License is in full force and effect. O ch License # Lic. Class Exp. Date ti X 9147:5f3 L'l0 5/31/2( � Z r- Date J %' ? Signature of Contractor. •�'' � to 0. "r ,1' J U t�0� OWNER -BUILDER DECLARATION HLLIJ I hereby affirm under penalty of perjury that I am exempt from the Contractor's U) 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). C0 () I am exempt under Section B&P.C. for this reason L N Date Signature of Owner ON 0) Q WORKER'S COMPENSATION DECLARATION CL C:) 2 Z I hereby affirm under penalty of perjury one of the following declarations: 0 ( ) I have and will maintain a certificate of consent to self -insure for workers' X W u- compensation, as provided for by Section 3700 of the Labor Code, for the. 00 J Q performance of the work for which this permit is issued. Q U ( ) I have and will maintain workers' compensation insurance, as required by 0U Q Section 3700 of the Labor Code, for the performance of the work for which this Il LO Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier 1 Policy No. �a J (This section need not be completed if the permit valuation is for $100.00 or less). (F,' 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 agres,3hat if I should become 3 subject to the workers' compensation provisio (Section 3700 of the Labor Code, I shallJ'�orthwith comply with thoseroV slops.21ca .Date: +`7 J Applicant .�y��� 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 dao & 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 lawVrelating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspofi purposes. Signature (Owner/AgeDate t BUILDING PERMIT PERMIT# —4K3i?8-U%9 DATE VALUATION LST TRACT _ 6kBA)If20C uaw.00 y3J� JOB SITE APN ADDRESSa-�.t®E�s°�1Or OWNER CONTRACTOR/DESIGNER/EN (NEER FJES' .W. DR "Pi PROPERTY MCiM Ts .ADOBE I�:�,E MYC' 74R050 ALF-SDAI-TD iO r)X :TJrE B - . . 35-325 amn-ORAAANE PALACE DESERT CA 92260 CATTIMRAL MY Cdr. 9"7,34 7610 30�J USE OF PERMIT E.LECM..C;AL METM PA14EL C.HAN©&OUT TO )25 AMP VALUATION 1,240.00 Ls t, • Cob -,r OF C"ONS"�'7.ZTD'+I:�"!IOIq 1,200-W ••te�l},;�gg��xx,�� �L p/� y]�';m'f�il�e'+: zy ELECTRICAL SEE 1 q] -000.420.000 TCM09 AND PLAN CIMCK $3:3.50 UZZ1 PR PAM M09 $0.90 �,�, 0 1 2003'... P :SEES DM HOW CIT1t O; !-A GUINTA it �apl: F. Ql PT.. RECEIPT DATE BYD FI ED INSP y� i INSPECTION RECORD it OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts t 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 Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 OX for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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) QD