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0004-181 (TT)r LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Ch. bier 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 S9�3 �` �:1 03/:31/x( Date { 561Signature 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 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 QQnStruct the Droiec1 (Sac. 7044, Rllsinass A Prnfes4inna.l4; 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. (z) 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 FREMONT COMP INS Policy No. SE30_115900.14179 (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, ,antd agree that if I should become subject to the workers' compen sation'provisloo=CSection 3700 of the Labor Code, I s all forthwith comply with those pw I i ons _ Date:/ �� cv Applicant— Warning: .r 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 forinspection.p rposes. j Signature (Owner/Agent) �' �y Date (rl'I '4 BUILDING PERMIT PERMT# DATE VALUATION LOT 0004-181 TRACT 04/1.7nOC 9101 .00 JOB SITE APN \ ADDRESS X97-8.32 V .I.P' ,C?KI NCE OWNER CONTRACTOR/DESIGNER/EN (NEER F F L tt CAUA1 Aid & COMPANY CAriADAY v COMPANY - 17480 E. 17114,7T°. #106 17480 Z 17*M M, 0106 TUS'1`RIT CA 92780 TUS`.t*.lRi CA 92780.. . ('714)508.4440 CEiL41 4485 r :t 7 f USE OF PERMIT SALES 01PFICE TRAILER V.AT.UATIO14 10,000,00 LS y RSTANXM COST OF CO1112U ON 10000,00 A�A1JyRE 7ubJ�R TEMP CONSTRUCTION TRAILE.) 101-000.423-000 FaA0,4A ffUl-1-1YrAAL CONaNMV0.1 011 AND PLAN CE KI $200.00 LESIS PRE -PPM �"k'ss� ftoo RECEIPT I DATE DATE FINALED I INSPECTOR 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 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: I 93-'38-96 19:95 City Of LaAuinta Comm.Dev-Dept ID= 766 777 1233` P.64 City of L'a' Quinta -Community Development Department 5 78-495 Calle Tampico ,d - La Quinta, California 92253 OF - (760) 777-7125 FAX: (760) 777-1233 1 APPLICATION FOR MINOR USE PERMIT APPROVAL { MINOR USE PERMIT applications are'reviewed and approved by the Community -Development Director pursuant to Section. 9.210.020, of the Zoning Code. The purpose of the review is to ensu' 'that land uses requiring the permit do not have.an adverse impact on, surrounding properties, residents, or businesses. - APPLICANT MAILING,ADDRESS `�% S� • 10�hone No.�� y�50 ' (4 t+O CITY, STATE, ZIP: + Fax -No. qL14 , PROPERTY OWNER (If different): - r (Print) MAILING ADDRESS: Phone No. - CITY, STATE, ZIP: Fax No: PROJECT LOCATION: PROPOSED USE AND/OR CONSTRUCTION (Including operational information): �CX P� ` (attach sheet.-, if n . dei C PON (La LEGAL DESCRIPTION OR A.P.N:): ��� ��q► S�= � �'�� ;� : ,. �1� 0013 + A] Minor Use Permit / COACHELLA VALLEY WATER DISTRICT CASH RECEIPT,DETAIL6* � q'834t -1.8 Received from; f f 1 t,..+ ( 1 C ; i '" :a7 _ % Date:- Address: ate Address: `"! j ; / �,? "¢ �j C' • f../' '! f` I ��� f ! ("�' :� Account No Lot(s) Tract - {.. r f .I /:. f.tif / K� ,,3 - y Sery ice Address? kr~ %'r .� r-, ;7r f G.A. Code F }. r � M f' �' , ❑ Servlce(s) ❑ Backflow(s) ❑ House Lateral(s) �YDetectorCheck(s) f'f ���y• f )�•`. ❑ Meter Surcharge b- 6nitatlon Capacity Charge i f (1 'moi ra s .GYW.S.B.F.C. , f / E_` t %. t' '(... ❑ Temporary Construction Meter ❑ Turn on Charge ❑ . Uncollected Account Name ❑ Inspection Fee - Tract. - Fee - f ❑ Plan Check' Fees Water l Sewer - Tract - ': ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit fi ❑ Other w • . 9 F>" r 4- TOTAL $ a Remarks: !h ash Water Service Check • Money �) ° + Cashier order 1 t i s r- CVWD 438(11/!39) . s