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0002-142 (ELEC)LICENSED CONTRACTOR DECLARATION ;,t-erebyaffir'm under,penalty'of perjury,that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 'f Professionals'Code, and my Llcense.is in full force and effect. ' License # �: ' _' Lic. Class Exp. Date + &16826 ' .B ASB t# . -_ 06130/.-01 Date �" n ' 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: 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). ( ) 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 �� •- rf Date. =+'✓- Signature•.of Owner., �.r~,fet �¢ / /��•,..+ WORKER'S COMPENSATION DECLARATION I hereby affirm:.under'penalty of perjury one of the following declarations: ( )y I'have and wil6maintain a certificate of consent to self -insure for workers' compensation, as'provided for by Section 3700• of the Labor Code, for the pgWormance 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. A� GONT AT..Y s (This section need not be completed if the permit valuation is for $100.00 or less). () I certify that in the performanoe.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 vGode, I shalfforthwith'comply with those provisions:`' Date: ,�i .:c_: s)4) 'Applicant , L I Warning: Failure to secure Workers' Compensation coverage is unlawful and" shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation;, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on'.his application. + 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work.is performed under or pursuant to .any permit issued as a -result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents, and employees. 2. Any permit .issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work.for 180 days will subject permit to cancellation: • I certify that I have read this application and state that the above information is _ correct. f agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives.of this City to enter upon the above-mentioned property for inspection purposes. psi nature (OwnedA jerit) ­/,L-� "�3' "' ''" � "r' Date A � BUILDING PERMIT PERMIT '• DATE VALUATION '��©ia,��3 LOT TRACTJOB SITE ADDRESS 49,36 0 VISTA DE,NOP AL APN - OWNER CONTRACTOR / DESIGNER /ENGINE �,: t sry I ;J : i,.t, °.r; VAI.,.r';,f•I aNC0\1 pTC 48-300 %, iii rA. DE NOPAJ, 3276 ROSECRAti G"I ., a%D FLOOR,:. ' = LA Q01NTA CA. 92253 Slur D11ER O ict� .�allr rri t x)2.25-�) 1n7 rBLft 25:30 USE OF PERMIT (5)- "14' nitsTAL LICA{% rpt: LE.8- (PER AIPPRO- u %. Alv s 01if i . Vr LUK1710N 2,00.00L,3' .A'�'d�,Y�k. V8•twaQ'.i' M�+Vw7G 4s.M! ar..�l�`'i.4a�.,Y,..�o el Q�••ss.I'.j,Wr irYiit �l•i�y tii '! PC RAUT P1. RIP, SUAIII%Wy .0.61Ci't CAL FhC 102-000-42o-000 � t ,, !ev (j`J ammi 1ti11;71I�1 y-.�,� }^q • { _ .Li:,. SSS PT ;7 .11W) FIESES -14,D•r;kuT .Y,..9;F.LVy.Y @ R`,Y�.S:A� ��JyL'� �����V '.$�.A8. l5 a, RECEIPT DATE ! BY�t� DATE FINALED INSPECTOR 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 Exhaust Fans O.K. to Wrap 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 Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric s 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 Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voftage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: