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0008-120 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury.that I ani 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 t B 07/3 Date "" r rr - Signature of Contracto' r tires' OWNER -BUILDER DECLARATION i• 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). O 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 STATE WND Policy No. 046-0007333 (This section need not be completed if the permit valuation is for $100.'00 or less). O I certify that in the performance of the work for -which this permit is issued, I shall not employ any person in any mann!6 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 ohe Labor Code, I shall forthwith comply with those provisions. Date: s, l-,,I-•µ*� Applicantj° { Warning: Failure to secure Workers%Compensation coverage is unlawfwLa d shall subject an employer,to criminal penalties'and civil fines up to $100,000,lin 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 becomesnull 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 h'ave•read this application and state that the above information is correct. I agree to comply with al.l. City, and State laws relating to the building . construction, and hereby' authorize representatives�-Qf this City to enter upon the above-mentioned property for inspection Purpo'sesll , Signature (Owner/Agent)• E"�•✓.Date BUILDING PERMIT PERMIT" OON-120 DATE f CC VALUATION�e,t��cq� eaa� LOT' TRACT �t ^s t 1 J.Y.7.f,a4crgd4 f 2P 5. ! 1 i I f� . f',•t1: JOB SITE f APN ADDRESS 49�-.1.5A� .0 YXWES-MIMLA. 649-100-00 OWNER CONTRACTOR/DESIGNER/ENGINEER M i?1::Sk.,3Ee,',l° DF_ ,0Ph& T VA RKS CON•S!"!?IT(MON PO BOX 1716 '79-2951:W I101AQ'iJR4'IADP. %A ('UW"CA CA, 92253 1A Ql 1 fA. ; CA. 92253 i (760)771-1941 ,CZL# 2996 USE OF PERMIT .y sm-1..&P81 PL64113R. > PERA9 , ' DO.FZ NOT INCUiD.4 FaccY;Y4'.ALLS OR POOL. 751% PLAN CHECK E'411EDUCTION FOR. MULTIPLE Ys SUANC11 O SAME PLJ,WTYPE. C<USTOW4,CONSTRUdTiON 4,24100 �F FORCH/P.ATIC) GARA(MCARI'ORTf( F� 12,99.x,00 m . M COST F \:�.�.6`TV.�'t�1i,6. 0K - .iyk5d p7� a74} gqB gp�•t •�JgL';67ddJ.V.R y�•y.q VER PF ,tXl.� 1'.AJ E R. S V,AW1i91[•1.Ct. CONSTRUCTION IRE 101.000-438.000 591521150 <-4, 'PI:Atd CHECK FEE 141-At10-439-318 $��8.73 �, :j. � �• «... M190MNICALML7 101-000.421.000 nEcTRICAL FEF 101-00"20-'000 PLUMBING"Z 101.000-419{)00 $203.00 STRONG M07-1013 FEE e RESM 101 000-2,/11-000 $33.14 r „r GRADI.NO ME 101 -000-423P000 120100 DEVELOPER IMPACT 1-.8, $3,403.00 :ART IWOUDIAd PL40QS, RES11701--000-255,000 93378.47 SM-TMAL CpWrAITCUOY AND PLM C E.CK $4,759.(25 >. R .9 PRE,: F'A[3� 1' ' :.9 $0.0© vIrAiJ P.YsSi«'Y9a S a:.:F:^S7 �'V No 17"3g f i . V RECEIPT DATE r tr` BYn�ah DATE FINED ` INSPECT INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs _ Forms & Footings -3 z� �l Slab Grade _ ff/ _ 4 Underground Ducts Ducts Return Air Steel Combustion Air Roof Deck �p O.K to Wrap Framing 3�> Insulation ( _ _ Exhaust Fans F.A.U. Compressor Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ 3f/� Final — �} Final — l' 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 Sewer Connection Pool Cover 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 W��? Utility Notice (Perm) G