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0008-126 (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 # - Lia Class Exp. Date 67x40/7 r' �{ 13111 Date d`�,�- `' Signature of Contratcto� - 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 . Code). O I am exempt under Section B&P.C. for this reason Date I , 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 FUNr•► Policy No. (Thissection 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 mannso-as to become subject to the workers' compensation laws of California;16nd agree that if I should become subject to the workers' compensation provisions ofjSection .3700 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"pu rpose , Signature (Owner/Agent),' I Date r BUILDING PERMIT PERMITk DATE VALUATION LOT - �'`TRACT 1 £ 1 4 vsxAwo 9 29457.1 JOB SITE APN ADDRESS 49-19 VISTA 1f r. •.,i�.EU.A _ 649L-10"09 OWNER CONTRACTOR / DESIGNER / ENGINEER TD DRMTD1XFL0FhtM1 SPAIW CONSTRUCTION FO DOX. I? 11 79.295 RAN CRO !A QT3NTADR; LA QUWA. CA 02253 LA QUDITA CA 9224 (769)771-1941 Cw 7996 USE OF PERMIT ��!/ SWG GLER 1FAT�2t� •Y DWM1X fG: SBD- Li3T:0 NI.,AT°IN3 • PERMIT P.. ORS NOT INCLUDE ti1,.00CK'tiUA= CJI . POOL, 75YQ PLAN CHECK FEE REDUCTION FOR MUump i,1; T ssulvMCE 0.0 -SME PLAN TYPE, CUSTOM, CONOTR.UCTIO14 4,243.00 97 z PORCH/PATIO 33%.010 S1+' r OARAGRICMPOlRT (SI) 13g916,QQ ES17MAM COST OF CONSTRI !'C7TON 351 13 9-30 FRRW.r FRE sUMMAW r ... CON`1TRUCTION FEE 101-0001-41€-000 s1,snso PLATT CHECK RI^'. 101>t300-�t39>�1£� $JU13.33 � �: f PdiECHANIC.AL PER 101-000.421.000 5136,", ELECTRICAL FEE 101.00A 120-OQ(T $246,71 PLUMPING PER 101.000.419.000 2205,00 STRONG ITC+T'ION PEE = RMID 101-000-241-000 0135,114 OR ADWO F'VKE 101.000r423.OM $20.00 DWELOPER IMPACT AIS sI,ltY:? Oa AR`T IN FUBLIC PI AC ES RESIL 7014000.235•=000 SMA? SUB©;i'AL CON -',Pf RCICM..©%a AND PLAN C"t3F.M: $4,759.05 LESS ',PR,1?,-PA,1D liiW $D.00 TOTAL 1r'KFMT F'UXS . XTE NOW RECEIPT DATE a r BY e9 DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & FootingsZy/al /, , Underground Ducts Ducts Slab Grade _ �� ( Return Air Steel Combustion Air Roof Deck _ _ �d Exhaust Fans O.K to Wrap J _ 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 I z 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 Waste Lines V6 '� Electric Final Heater Final Water Piping G Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral / �3_0� Pool Cover Sewer Connection I%'J Encapsulation Gas Piping Gas Test �J r�/a Appliances Final PMMENTS: 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 71 �� Utility Notice (Perm)