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0002-047 (SFD)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 'Professional§ Coae,•and my License is in full force and effect. License# ' Lic: Class' Exp.. Date ' t�7wi&74 1 r,�� . Date � Signature of Contractor t OWNER -BUILDER DECLARATION I hereby affirm under penalty, of perjury that.1 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). , . • .r ( ) I, as owner of;the.property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). �. O I am exempt under Section B&P.C. for'this reason Date Signature of Owner' WORKER'S COMPENSATION DECLARATION 1 hereby affirm under.. penalty . of perjury one of the, following, declarations: µ ( ) ^I have and will maintairi 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.. ( ) 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., i ` Policy No. ' , r:� l ;i� a t�.A.• \tsV��. . _ tl'`c�r»%3if4 p'�•!J (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, l shall not employ any person in•any manner so as to become subject to the workers' compensation laws of 'Califomia•, and agree that if I should become subject to th"e,-workers' compensation_ provisions of Section -3700 of the Labor Code, I shall/forthwith comply with those provisions. 1 Date: Y �r fr' 'Applicant Warning:aFailure to secure Workers' Compensation Compensation coverageis�unlawful and shall subject an employer to criminal, penalties and civil fines up to $100,00 in addition to the cost of compensation damages as provided for in Sectio. 3 06 of the Labor Code, interest and attorney's; fees. /J IMPORTANT. Application is hereby made toethe.Director of Building and/Safety for a permit subject to the conditions sand 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 has alresult 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. Iagree 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 purpose's. Signature (Owrer/Agent) p Jl, BUILDING PERMIT PERMIT#1� ,.yy pp�pp �YiIV.C.^�3'J•l ♦ •DATE . VALUATION ��}��1� �' LOT 67 TRACT 29306 JOB SITE' ADDRESS 49-404'•1 VIO.A�Sd,?aLOMINll APN OWNER ' CONTRACTOR / DESIGNER / ENGINEER �rl� rti,~cr o'r'r� e`!x r nn rtt rr lirIEN 1. •Ti re U w � lin%*i�vri•rat rr-r rn'nr - , 0.1 A!\ImJj �rV1y IJ F 1\\J4 L,\JLI P060K 0K t7i6- 79-195 ccXCICHO LA, QUHT:ADREJ, {_,.A QYIN:CA CA 92.253 LA QUEM A• CA 91253 r USE OF PERMIT �T f3NI C3T 61*PL \,N Nf d PRN l.t 1OF S NUT` ll -TC .`i5DL T�x,OC'rWAIL Ok f°t OL. 15-A PLAN OtEC:tC f�ES REDUCTION TION r0R A3i1LTJ.Vl .E 13NL �: CH Of. SAME PLAN I'1PE 'a r 3.076.00 5 - .• ` . ► ���, = � u W.OG 8 , CiAs 11Ss.Efa:lAfClrs7tc;' 693.0Q Si` v ' j� YM•i PR A'g'.K��'�"D M1..�;.Y s ''�d,Y7� A. `s.I1.%;J L'S i'l.. i:r'� p "z6a n .moi ...re P.V',RM1 E4 KF, 8U,MNli.fAsKV CIJNSll cUCTtf1I+f FFE .101..-000-418-000 $1,20-100 ; Mf,;A:NrCK3i 4.1I l-f�Qf►-tlU:3 j f� ��s?.f?'? n�1I/� .ognn ryn SVAAi+I..d=xl U!i 1.�,.f13,. ,1'r A:aC3 !1!R-VVil-�si VV' •,D l4Y.UV , mlt, mal YCY b'IZE 4.0 f -000.4194)0 r�3.Uo ', F74>rlC: ioAO't'!f)nd w,I S_? ESH,)ICII-Ciflf 241 )Q0 G:t�1S3i zC T ;T 1011-000_1123 -004 $ntj.UO 1�I Z1 �F!irC:i%rlt3aiQ! nm !'t2t1fls f-1(A3.LK`, , LAC88 -0.iT2f Silo ?U;: -o00 -2S., -i U00 $402.29 I; Ti S-7 Y? r�.r; CCS IS�°�t, ( '10 V>4`D 1?i...�,N �';H�C 1C e4,,Z17.91 L. SS PRE -PAID FEES S0.� _V.EES ONCE OW S-0.17.97 -. RECEIPT 7 DATE BY /� J DATE FINALED INSPECTOR J,s . 11'•11 •' � ... .. _ - r- , INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs �+ Underground Ducts Forms & Footings (Gv Ducts Slab Grade Return Air Steel Combustion Air Roof Deck – p—a-c> Exhaust Fans O.K. to Wrap F.A.U. Framing pv Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wali insulation - Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final .– � �� �-- Final POO SPAS BLOCKWALL APPROVALS 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 COMMENTS. Final Z– 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 3 Temp. Use of Power Final Utility Notice (Perm)