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9907-416 (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 at' e / Signature of Contractor q10 ° r`� I d OWNER -BUILDER DECLARATION I hereby affirm under penalty of 'perjury that f 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). O I am exempt under Section B&P.C., for this reason Date'. Signature hof Owner ' WORKER'S COMPENSATION DECLARATION" I hereby affirm under penalty of perjurq one of the following declarations: O I have and will maintain a certificate of consent to self -insure for workers' compensation,, as. provided .for `6y 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 1 �}';I� �•� Policy No. dd l� 9�'• 1 A %1.*1 lei 1' U14D ' - Nc I-r�.7�'-IGM111 (This section need not be completed if the permit valuation is for $100.00 or less). () I certify that -in the performance of the work for which thi§ permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if 1 -should become subiect•to the worker compensation/provisions .of SSe�ction1'3700 of the Laboi ,h�ate111 a%v�o�tthW`tApplicancomply with tfiP� os$�,i ��l ll��Sr!i Warning: Failure to secure Workers' Compensation coverage is unlawful and. S 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 appl'icaton 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 or inspecfiori purposes: 'rYr��`�'�'f j we 0KL� gnature (Owner/Agent) ✓ �' r �' " Date' BUILDING PERMIT PERMIT# ' • TRACT DATE / VALUATION_6.� LOT 84 JOB SITE / J -�. ADDRESS 'V_4io Cb1lLU W JSFA VERDE APN OWNER CONTRACTOR/DESIGNER/ENGINEER �/'1J 11 �.i 1i Zt�±° :.i VTr1 J r lj NA Ci.':��f0-yQr♦may rIJE�l,li\J'tI..L�t.1{J h�lP..wl:ili^.1AtlEl.7.CD..1r�+./A.r.yl.a�lis int' J'��.i`/1 •�+..�g�' �. �"•1 1. tj• Z4 B1." �1 � IS�'J IB.Y,/1 4.f'i+li.7.AJ"4/.'�;1.�1�F.J ��IIL.r��Ir^,.E�.�,.�i 1�v,brrp,iJ•Ei,/. rl-9(K) A'vEWLIE OR'ME, IMI"fi;US ' . T7900 AVENUE OF YHE S'i°AMS PALM lah."S.E'RA..' CK 9.7.21.1 PALM yErrSeeERY CA 912✓"�,j:11 (� USE OF PERMIT SENOl.,P,;t"A4V;`fWV t~:1VIP.ULNi"v Sr 11) 3A,•PiwRMT'001FS Nai U,"C LIZE, IMLOCX W.M.f O13 w z Y POOL. 'dSao $'.1 AV lUffP'.'C;K FFE FOR MUE.IIPL E. TSSCdANVE OP SAW, PLAN t - • � •i 1.y:Ma i k.. � TRAe~,x CONSTA 2UC.'i10N 2.n'7JC.00 Si PokC.ESfPKC4.0 1120.0 S.F OAlliW&CARPORT . ~S1A[iAR��'A:c1I 'WaJ,i1. 31 4.4.IL.'k \:Y .b .O I�J i..r �.W,'LeS 1. .PERMIT FEF, S$J.WWAM CONti'I-k(JC!f(ON FEE 101 -0004;M -OW $'1;6.f1i1 'AN C 4T,CK FEE 94}4�ti�O.:t�� �lK glt ifi9' i EQ.11ANs^f'+.1, r E 101-000-192; U6,50 Ek.I��`.Txt tf,r'a9:::3' ..��1 i-�'D()�_t�2t�-C€511� $150.48 PTX%1UING FEE 10140-14 19-M �2't"l.Sii swRriNe" monr�r l..T;aJ 101 -000-2.11 -000 $: 5 � aRFlDii'\f s FEEI 10,1'-000-42.0000 iT�fE'>t�a 9'(:.isC'TS1kiL"F98 VrHEC;t:` E PLAN 101-Ot}(►•-441-345 s, I) ART 9N P VMTC iii'„{ CF3 . R!-NI1Y .701, 0f'i(112 )-9(V �Sn6 SZtBITYML C;c,A1vYS'1'itVQ NON �VDrLAIN'HECK. . ..0ti/ EESaE%S ; "ALLJFEES $tl?0> _TfffeEJ-1 WGliIL@FIS .NOW - ��i;�ViD�O•.Y . RECEIPT DATE BY, DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms &Footings9/Z= C Ducts Slab Grade lye ;7=f" L Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing i— 7 -t -4m Compressor Insulation 2 - Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 2, — 14 .- to ' 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 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 toEncapsulation 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) .-Lt _