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0007-033 (MISC)LICEkmL NTRACTOR DECLARATION I hereby affirm underperjury that I am licensed under provisions of Chapter 9 (commencction 7000) of Division 3 of the Business and Professionals Code, nse is in full force and effect. License # tic. Class Exp. Date 5 1 61% B 03/31/x( Date �r'`'1 i 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 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). () I am exempt under Section B&P.C.'for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby'affirmunder 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. 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 FRFMONTIC;OMP 1148 Policy No. r�ry�,1193f6©-141`1St (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 riot 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 shat} forthwith comply with those,provisions.f Date: Applicant— Warning: pplicant 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. 4,_� Signature (Owner/Agent) ;�S-#x ,�Date- 7,V'00 ate 7,V'0v BUILDING PERMIT PERMIT# DATE VALUATION LOT Q07- TRACT x. .00 245 261.52 JOB SITE APN ADDRESS 47-740 VIAMONTIM W-12.0-017 OWNER CONTRACTOR / DESIGNER / ENGINEER CAWADAY & COMPANY CAMADA3i & COWANY 17480 Z 17TH OT. #106 1.7480 R 17TROT, 0106 llror ' CA 92780 ITUS":l'Od CA 92790 (714)508-4440 CDL* 405 USE OF PERMIT NIMCEUAMOOD (1) AOAT DOCK -PER "PROVED PIANS ONLY VALUATION ZS00,00 L8 X197MIATED COST OF CCiIqS'MtTC1tON% PLAN CHECK I' r+ 101-000.439.318 MAO CONSTRU.- ON .1?1 E 101 0000.418-0013 a .F30 1 ` 4tii SUB -TOTAL. C01QTYR (,-r10N AND PTAH CBECIC $89.10 IMS P_�-PAID FM $0.00 TO IAL 1'1'..1"MI 1:i'�; �S DIME NOW $89.10 RECEIPT DATE rBY . 1 0It DATE I olo INSPECTOR 'a INSPECTION RECORD OPERATION I DATE I INSPECTOR OPERATION I DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs -Underground Ducts Forms & Footings Ducts Slab Grade Return Air - -M Steel Combustion Air �f Deck Exhaust Fans '-,.. to Wrap F.A.U. ning 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 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs. Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg, Test _ Final —00 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 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)