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0203-100 (BLCK)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 bate �'' 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: ( ) ' I, as owner of the property, or myemployees 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 d6mracting wim 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. (Y) 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.STME W10 (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 becomesubject to the workers' compensation laws of California�a�d agree �h�a' "' V�ould become subject, to the workers' compensation provisions of • ectl 6nJ87 of the Labor Code,' I shalt fort ..wJ ttLcomply with those 82_11 ron /� ....�'" Date: �,/%/. 204rApplic int 1171, 1�«^. f � Warning: Failure to secure Workersr�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. 71% " - 1. Each person upon whose behalf this application is made & ach person at whose request and for whose benefit workis 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.e i 2. Any permit issued as a result of this application becomes null and void If work is not commenced within 180 days from date rof 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�S`ate Ipws relating tolthe building construction, and hereby authorize represe tatty s of this City ,to ;enter upon the above-mentioned property foYnspectlon purposes. Signature (Owner/Agent) Date fes, /BUILDING PERMIT PERMIT# /JJJJ/ DATE _ F NLUAT; ,N LOT S "� TRACT E J Gy JOB SITE ADDRESS 1r":4�i1 Fri iliCMl`V a.. APN OWNER CONTRACTOR / DESIGNER / EN (NEER 17480B 1?7H3T,#1W rir .�1 CA 92180 TUSH (714)508n6Y440 C'M## 44M USE OF PERMIT ?YECEp AL ByU7 O, „92 T...I;. 6' z, L, f k' OARrjFN' 07'iC+uR 3 is' "s°°j'>?A q: p` 6 Yr, WALL 92,00 LF. d 1-7. WALL 27.00 Lar 1bT=&Tr.0 C067 OF COMMITC170117 2,732.00 ;C'kaMif 3b:IR SUMMARY d G'4N3:P9t�1G`'�,it77'� �� al31ntM1(�^�"4'i.�i9f1L5© ��t.f< ' ^'^` X LESS. R Ci.CY°X t2l.J,jI'M S: ppy �tY4r'a tTs 101010 ear Is AW-Vt rMaT F, EL D Ur. NOW S54.jD0 ryE. r RECEIPTDATE DpTEf BY' � ....�.. FINA LED INSPECTOR r 14f�� ,03 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 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 BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam _ `Z> - Z Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final , 0 3 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 Set , r 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: �� ✓�y cd - p` 7' co OF 3• M/N )IV CANCERUNI1S ON �B)"gao RETE PAD TOP !y OrP��ErF 4p 02 F,pp R=29J50` L:68 dB' =1376? T_ 34.60' / m S / PLAN' 30A -R 2 ' / LIVING AREA 3 034.0 S F, Fq GARAGE AREA = 630.0 S• F. LOr,4715 3 FF: 61.10 Q h PAD' 60.60 a P / Pool lb OFLA4 `._DING & SAF QUINTA ETY` FORPPRDEPT Co ED ` I NSTRUCTION SCALE. 1=20TE_3-� BY —4 LA D 1910 S. ARCHIBALD AVE., STE. N EVELOPMENT ONTARIO, CA 91761 909 930=1466 B $ $l GN FAX 909) 930-1468 47-690 :VIA FLORENCE YORPORA TION PLAI%NwC • ;CIVIL SURVEYINC LAKE LA OUIN TA, LA OUIN TA, CA 92253 DATE: SCALE: SHEET708 No, OF WA PER LOTS 12128100 '10=20- 1 3165 LOT 115