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0002-133 (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 Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 674074 D 07/'J 112( Date 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Cod©). ( ) 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. ( ) 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 ST 7fE FU-l3ly Policy No. 046-0007"S (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: Applicant 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. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# DATE 04l1)3%2(X VALUATION 117.10 LOT34 TRACT 29306 p e T$24UaA JOB SITE ADDRESS 48-310 ars51.A 4CALcC 0 APN 649-10&D1.9 OWNER CONTRACTOR/DESIGNER/EN (NEER M Dm.;W DE.^c3-RIL.OPIAENT SIPP XS CONSTRUCTION PO BOX 1716 79.295 RA14CHO LA QU rfADIL LAQTJWTA CA 92253 LAQUINTA. CA 92253 (7(507'171.1941 01314 299E USE OF PERMIT SW0T..1r?+!• WLY I WIRL 2IG F7) -LOT 74 PL A14 FJOR, PERIVIT DOES NOT INCL UDZ BLOCK WA.LL3 OR P001.75% PLAN l;k:ECK FEC.EEIiUCTI014 F011 MULTIP-1E jtigi_ir>,i�t�RO BAMF, PLAN `CYPF_ CUSTOM CON,9TRUCT1O}1 2,924.00 SF PORCH-UPATIO 235.008F GARAGEICAR.POIRT 470,00 SF WIMM A ? C09r OF C0NS,M`UC7E70N 240,117AQ PERMCr FEE SUWB4ARY CONSTRUCTION 1;EF 101-000-418.000 $11133.00 PLAN CHECK ME 101-000.439-318 $232.24 MEC RAWICAL FEE 101-000_-421.000 $120,50 NI.11wTRICAL. E2L 101-000-420-000 $169,24 PLUMBIHO FEE 101-000419.000 SAW,75 STRONG MOTION FFE - RF 31D 101-000-241--000 $24.01 GRADIN0 YER 101-000.421.000 $20,00 IDEV.ELC3r>ER J ?SACT FEE $1,907.00 ART FN PUBLIC PIACES - RESIE 701.000.255.000 $350.29 WB -TOTAL RUC`r10N'ANDPI-AN 'CHECK 54,142.03 L,Epp:.1S�yPRE-PAID FEES ${0.n0fl0 +y e A��y ,y�.t yy��w�t �ryt+.Tr 1 O,.VA i i Sv���► I FEMME 7 DUE E NOW �}r,� D4,142.0 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings U �� �� (O Underground Ducts Ducts Slab Grade 43— Return Air Steel Combustion Air Roof Deck _ Exhaust Fans OX to Wrap Framing I �� �j F.A.U. Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls loe Party Wall Insulation Condensate Lines Party Wall Firewall 1110, Exterior Lath 2 �f'r GYJ Drywall - Int. Lath Final Final �,/ BL0CKWA .L A PROVALS 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 _ Waste Lines .pp 6 Gas Test Electric Final Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection _ ��� Pool Cover Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: /hers -a -•r% 6�.,c e�=z�-u� Final Utility Notice (Gas) ELECTRICWL 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 /J Utility Notice (Perm) 7J( 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 oilt'11120i Date G 710 Signature of Contract OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 1, 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). ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals () 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. ( ) 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. C --f• T Y'� i'Y iR oe,1{c+r " tYtV�197V1 iA� I 7 (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 mannnprasQas 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-o the Labor Code, I s.al forthwith comply withithose provisions./i Date: Lr %�e Applicant rr 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, indemnity & 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 propertyfo mspection yurposes Signature (Owner/Agent) " BUILDING PERMIT PERMIT# !)i1fI7.3,�5 V DATE VALUATION 1920f $' 1 LOT 34TRACT 243116 ADDRESS 49-510 AISTA ICA.IL iCO JOB SITE APN OWNER CONTRACTOR/DESIGNER/ENGINEER T j r?uc 17 �-s `�t?�rtrj �°�te 11 r %;0 A;s rr c� .Cap"� :�t rrti�•rr ant ..I-V/ ?.1 IA 1. 'em I, \ [1.l+� V. PO B0.1Z 171. 5 79-295 JL+'1NCHO LA QUINT& ISR LA.t,;►iJlNTA CA 922YA LAQU.IN1'A CA, 9 253 (764 CRIN 2996 USE OF PERMIT S>.NuLfi I•'AMtLV IaWT.:I/ ANG !. t o-i3OT 34 ill, AN:l 20R- T -EW- I DOES 1401 WCifJ.r;iE BfC CT%. W-rtLLS OR O.Aj.L.75`So PLAN kAilrt: K kliE K UiX"I'X).N ,F(_) t ivilJLTIPLE ISSW ttNC H OF SMIE e` a l.� vel i QIJ.S't"i�u4. a. aN .^.,!9Wi.00 t1 Pt"iftl TO."°A.[ 1Q 235.0f) S Cst'1i 1t3IIc:.tlfft'C>:!t'b" 470.V0 3F �•-- AIt Al AV*r* L43 `�-..iu�8 (+.b MS.iI�V i.i.ii\�'t., sits h9 ,�L �.i��e.� .aIIs PR, .ikNiJi A i+ le, i Ut14NidAR z i NS`1'!?:llt."i'tC 101-000-41g-i)W $i,133.fo) Pl,f�Nf'if1pia t yr 101_(lt4M3O-3119 %732.ia P4M711l' NfC.A,L rr—C 1Ot-OW-;2.I-000 1131).50 UJE.r VllICAL l .t1: 101-000-420-000 �iAi�.z•1 ' PLIM41-INIQ@ 11"Elr 101 -OW -49-000 Ki'f 0-M-.'A40Tf0N FII V - RTrIT) 101-0ffl-7414ft R^.t A FAZZ 1101-000,423-000 $20.1)0 j6VM uif0( ikf -, Al T F E -E, $1, 90.00 .AWr IN 1'1`Fll,1t" .NC At:liS - 6,6810 701-000-2 x_000 rS350.29 Cf f A_*1r)0 A*f , f'f")N''M,11 If..TTON ANI'll i>f .FIN C M-.'V..h t4 tA) 01 f rIeC', 13r i3 car: 4' !. '.� nl, i. i,) + i. 10 cr)nn w1 M, 141'9A1. PER4.1,1' Fl?, EN 1)1JK NO%V �6.A42.413 RECEIPT I DATE I BN/,L DATE FINALED INSPEC 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 —Z _py Exhaust Fans O.K to Wrap F.A.U. Framing Compressor _ Vents Insulation Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPRO ALS 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 4-1 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: Q �,s� a �-1- 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 4 Final 001, Utility Notice (Perm)