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0002-034 (SFD)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provision§ of 'I— Chapter 9 (commencing'wlth Section 7000) of Division 3 of the Business and N W ' Professionals Code and my License is in,full force and effect. C ch t License # ` Lic. Class Exp._ Date d LLJ�rw �7f1 j' 071311201 ,•� /�r��tor r-Z DateYf '� Slgnature.ofCon J U coo . OWNER -BUILDER DECLARATION, LU Wll I hereby affirm under penalty of perjury that I am exempt from the Contractor's N 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). O I am exempt under Section f, 'B&P.C. for this reason DateSignature of Owner' • ' WORKER'S COMPENSATION DECLARATION I~hereby affirm under,0enaty 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: - ( ) 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 w Policy No. ` 44r •Cl"'C"t'!•ra'li-i •f.Ae'i190(�Y"1'�l� • U.A S�,d �.: .ld!.O l+it/ ehA4i•i!+/U /...•Jti (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-whick this permit is issued, I shall not employ any person in any manner---- as ib become subject to the workers' compensation laws of Californ! , and agree )hat if I should become - subject to thelworkers' compensation/p'rovisions of Section 3700 of he' bor Code; I s alldfOft With comply:with those provisions: �'" Dater 'Applicant ' Warning: Failure to secure Workers'. Compensation coverage is' unlawfu� 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 ori, his application. I ' ' 1. Each person upon whose behalf th_It`appllcatlon is made & each'peeson 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 Ouinta, Its officers,_ agents and. employees. 2. Any permit issued as a result of this application becomes null and Vold 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 allthorizee epresentati. es of this City to ehter upon the above-mentioned property for /iftspectio�.purp ses. .�JyfJ1 , Signature (Owner/Agent) / " Date `: PERMIT#, BUILDING PERMIT. DATE VALUATION S2(,pf1g J7.,,Zt) - LOT 54 TRACT - , 29306 JOB SITE �.yq 1 t 4, r 1 ? w'- ADDRESS !y0^(B57 VILwSr.�'�A }9 A Qh#«a. Ir". ri n APN 1 '�Sd l i�•• �Ci r' jQtt'i9 '( OWNER . CONT (ACTOR / DESIGNER / ENGINEER r f itt3Q�itJ��'S ( � r } 6 1 1s .r..:..\7 i.!Ir•i..�r•:.13 1 ..b l' ...i..,•.Y :50 QQ I z1 �Ita''rp� ! MAIC I'ii in9. wS !: 1..J1'.) �Y `i.J a..R i. sus a V1 0.800 U716 1 q 19-2.95zWNCi?: O %A M, fN'f A. DR. Ih JA QUIN`Ir1 + %t� 9'Zl•5? l...� f ttJliv'T >, CA V4213 ' (7601771.1941 i ;}3i.l 2996 USE OF PERMIT ' t 5 , ,) i,G r oar :PLAIT htf [ -,KERI!IT DOES NOT MMUDE DLOU . WALL CIR J'a;v3.:, fS°�e.t�3..,'„v L€;if�'� :15`e� t21�)3Cfc:.l: iOi� �r'Ulr r,9lal.: � ii�l.fi ISSI¢a\T�I(..fs ©r' A • . i:J�iCi�ti rGiv '�%:vvl'it>1V � ��i106 tt� '.zi' , S r C{Ail,Fl,.dstJc;ril•Clata.4�':3.'' 6!i3 cil3 5�' , '.4 r s;•1•rSlia A "f''P7"CA hP'eGf•�•.r'ex'! I'Ni'fit'�5"3"Y.II�'•fr•+•f"6'A'\�.� . d��o.f1A:1i11pti.s.�Ay god�'rJ.l.. i/�i ''l+vi�v i. i'a, t7 q,.ablJt:v ��''qq�,(a eag ^► ,�6� .4f,'v�J8.0.sCt.- - �r.��i ti'l,� Q � Aai�" A�..B. • • ",. .� ..Y�f.f'YA.lY�.!i CONS'Dti C'4'1019 FEE, 10140-4.111-11M — VLAId t' RCM. VF, l f).t fit?fl 4 0- 18 $247:07 .N011A1i.'CALi aii�e^t�fii` v1at)Qti S,A*211,00 FILECTIRICAL FEE foI-ut --4:.V0-11110 s2o5.sa , F4.tJt1/lBE.NG FR.7. 10143f1U-419-000 :ti`{ RO1V0 ?stn i'1(11V t 1 R348%) 10401 -241 -ON) f^fi E1 A t':fd.t+l'GdC N''.15.ii Sif1"900`•413' 00 DE, Vt�"L,Oprin. %l"�?:AclI ME _ $i;�t77.lttj AXT IN+ PUBLIC PLACES 1"'Es .0 14.1-00f d5 i-11110 S402.25i` .iTR'�€HylgT.a'..:f3N•}iii(,"�'[l)t1�R;:ii'F'i.iil`f C,i,3i,CriC • :.Sdir -f, 9L.Y.,M99ffRRljEES .. : 015fe,Now Aa _ :: RECEIPT DATE /BY j DATE FINALED 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 _ Z-4L-4rc.) 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 POOL - PAS 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 q Pool Cover Sewer Connection i Encapsulation Gas Piping Gas Test Appliances Final oe Final Utility Notice (Gas) 14 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 Pourer 61, Final —V Utility Notice (Perm) COMMENTS: