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9811-008 (RER)CO CV � W Ouch I--aLr) ' W o Z r— coo0 O JVr- F-Wa U) Z M LO N ON U °) Q d — Lo Q O LL 0 J J mQU � 0) 1�t Z ao 5 O J !. `• 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 5S,0i_1 �tl +Ji ri ,Date t Signature of Contractor— OWNER-BUILDER ontractor 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 (S66. /U44, busirliess & Hrofesslortals 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&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. (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: ? / f A !QT Applicant— ,. "" f Iyr• Warning: Failure to secure Workers' Compensation coverage iS unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. vSi'gnature (Owner/Agent) � ��Ax XA�--'f Date I/ I- " f BUILDING PERMIT DATE 11/ 2195 VALUATION S3.750.00 LOT JOB SITE 48-x.37 V Eii�.1i.�9i3'SA ADDRESS OWNER 11 1It11Terae / r 45137 V[A 14EWOSA I,.71 QQJTINI A USE OF PERMIT id', SID PIKIRMARMODEL PERMIT # 9811-008 APN CONTROL# TRACT 8574 574 646-100-003 CONTRACTOR/DESIGNER/ENGINEER 5738 A.1'1n"C1r'",,N DR CA 92253 Y1X,*C A VALLEY CA 92284 (760Y.1615-3014 C;131.,,'f 4926 TNMJUGI , NON-STRUCTIOTRAL AT: Tt'l'ZA. K -)WS %'M Ai )IRO ti.l~fi Pl.ftN IVALUTK JONv ,750.00 LS ' p' . 'ays(`?X$ED COST 0011 C)`STv;O"N Spp nAyyERSUMMARY PLAN C141,XX FL.E 1(134(100-439-318 S49.95 f �'0N1,'I'Q1Tr,,TI()N 3~1;t; )01-nt)(1-:(!x_(14(1 E3.0f) .ELE.CT111CAL FU L4/j. 41110-41410-000 S`1`.11,0140 WXf(ON F;E - RWAD .101-000-2,11-000 ,s z LESS PRE -PAID FEE 4a NOV § t g1( Utt a ln1s, ' RECEIPT 1 I DATE I BY/ - j'i I DATE FINALED I INSPECTOR 5122.45 $0,00 $122.45 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings tY Ducts Slab Grade - Return Air Steel Combustion Air Roof Deck,► L -t V_t? li Exhaust Fans fp Framing � �!* Insulation !�p a liz Compressor 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 z < BLOCKWALL AP ROVALS 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.1. Smoke Detectors Temp. Use of Power t Final Utility Notice (Perm) COMMENTS: Items for Bid L Demo wetbar and wall partition in living room &5o ku, -#-481'4UX LV S� 2Y4+ WA , 2. Remove fireplace,hear-h and tile; (�a 3. Rebuildei dr, surround and mantle; (r11Cf fid). 4. Raise header in dining room door, bullnose & texture;j�A R111F (til CA& K{-jL 5. Demo living room closet, widen opening and raise header (prepare for built-in cabinet 6. Move attic access toy or snot her location; 7. Patch dining room wall & texture 8. Demo the two door casings into kitchen; bullnose & texture 9. Demo ceiling lights in kitchen, rebuild to flat ceiling and texture; 10. Demo sofit and ceiling lights in guest bathroom & texture; . 11. Demo ceiling lights.in master bathroom & texture; 12. Remove 6 small tiles ; add baseboard in guest bathroom; 13, Relocate cabinets in garage. 14. Relocate/lower fireplace gas cutoff valve. �DxfPa 15. Install water cutoff valve for refrigerator. NOTE 1) Drywall, tape & texture all areas of demo & rebuild. -2) In proposal, list cost for each item separately. 3) Coordinate with electrician for lighting installation. 4) . Coordinate with interior designer regarding Item No. 3. 10/27/98 • as ' - � h M o 643.it ^ N • • n IOOfI•I Lot © • Ja n, O a a �. I//.., r a \ ; \ /. /'/a. •/t. a•Ia.,• '� • 0rry 01, I1 I.NM 1 s ,t ` Guar Je J9 ; 10 r'• t'•/ a.nw 1./la. ar/r fur J/ : , � ` . e�„ w • !J r � JI • !J J6 ^ •O • a.r 41 `O 3 t.R r..rq .. H .. JI• .. .,t> .. aJr• /•N • '• • r0/ ti i/ L ,h• ••,ON /1••IfI �. Mw. f,*rrr ,.r.J a.� •� 0 ri/p. a/ - O. •l. � ••Y 1/ • / I• a ,• 1.///. NA t•I/./► Lot rV S O.r•ar v / O. Jrar w ra• R 6i ®` aJ IJ i tj •� "'� i i6 ��.wrr srn p au.v. • nl 1'L � arn•.rr � � .rt L... O.r/r ar//r o..,�r; n11 .7 Q1 60 61 • � .' t J . rrr•n'ar/ t. '�• ' ,. , �. •J t p., rut �•/n. e., �-rr.:T+ :. It it a.. • ►� Q ; •tJ'4 J1, t 40 eJ I • .. ti._,• ' •, i/.1 A I.I14 1t V/ e.u•.. nuY lLq a. ... ••�� O2 n T .r y • r• . t'• O.uM �.rl/. t.ra rI16 yr // jr ,► tom. Ll ar•w aua. • •' •. ! © CN Cl -a •• O O e r t d e i �•I •- •'O �t i'1 ,• t,O .e au OL ••© Br+ ,J e.k • ► r • , t. .�. 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