Loading...
0211-183 (RPL)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 Pr6fassionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date age 225 B 3/'31/03 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). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) 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 EXEMPT Policy No. (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 pursuan£ 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 LEaRARD I...f4M T.EORiaRD LAM 111 CIDUAMA CMCJ 111 CHI,U...A MR. 0., ' PALM DESERT CA 92.260 PALM -DESERT CA 92260 ('7H�OZ340-98fs2 CSL# 6426 USE OF PERMIT POOL .A1,AR.A SJ8.ES.CtR!A'a'?S SMALL Eft LN P1..di,CZ AT PPJ WSPECTION EQUIPMENT MRCiAMRE NOT INCt.r.3DED POOL 1LNNOR SPA %000,001.1 ESHMATED COST OF COMMMIMON PLtkN CHECK 5YLE 141-000-439-3 1 S $465,30 CONS'I'PLUCTION VEEP 101-000.418-000 $72.0 ELECTRICAL. IrM -- POOL, 101-000.420.000 S0.90 PL UMB INN FhM ,•- POOL 101-000-b 19-000 $27.00 LESS IIRE-:P F- :I $01(i) �lWrf Y! IKES DUE* NOW $190.90 -ITY ®r LA QUINTA ,L RECEIPT DATE f s BY DATE FINALED INSPECTOR LDING PERMIT BUIL PERMIT# Y LOT DATE J' VALUATIONX.00 TRACT SITE APN ADDRESS OWNER !OWNER CONTRACTOR / DESIGNER / EN (NEER LEaRARD I...f4M T.EORiaRD LAM 111 CIDUAMA CMCJ 111 CHI,U...A MR. 0., ' PALM DESERT CA 92.260 PALM -DESERT CA 92260 ('7H�OZ340-98fs2 CSL# 6426 USE OF PERMIT POOL .A1,AR.A SJ8.ES.CtR!A'a'?S SMALL Eft LN P1..di,CZ AT PPJ WSPECTION EQUIPMENT MRCiAMRE NOT INCt.r.3DED POOL 1LNNOR SPA %000,001.1 ESHMATED COST OF COMMMIMON PLtkN CHECK 5YLE 141-000-439-3 1 S $465,30 CONS'I'PLUCTION VEEP 101-000.418-000 $72.0 ELECTRICAL. IrM -- POOL, 101-000.420.000 S0.90 PL UMB INN FhM ,•- POOL 101-000-b 19-000 $27.00 LESS IIRE-:P F- :I $01(i) �lWrf Y! IKES DUE* NOW $190.90 -ITY ®r LA QUINTA ,L RECEIPT DATE f s BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION s 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 steel POOLS - SPAS Set Backs Electric Bond _ (f " Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test O (— 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 Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: / CL () 'r, Ste— All elec plu s 10' from waters edge in. - _ - �. ' s Proposed pool Plans for: 51,-885 Ave. Obregon La Quinta• APN: 773-163-018 Owner builder Leonard Lam Tel: 340-9882 Y m In 10 �. H; 'O y r Ad _._ s Backo ro ert - 6 feet wood wall Y N CITY OF LA QUINTA SUB -CONTRACTOR LIST CD � �Cyo1l/ c�a � -� UY JOB ADDRESS L PERMIT NUMBER - L250AWD S/��'L� IAR,, W OWNER 'A-- - BUILDER 0_ This form shalt be 'osted on the "ob with the Building Inspection Card at all times in a cons icuous place. Onlypersons appearing on this job. Any changes to, this list must be approved by the Buildin Division rior to commencement of work. Failureto com I wiesullt nna shop list employees are authorized to work Building P comply of building permit. For each applicable trade, all information request must be completed by applicant. "On File" is not acceptable. stoppage of work and / or the voidance Name Desert Elite Concrete Owner Desert Elite Concrete Sandpiper Plumbino La Quinta Air-conditionin sification I License No. Exp. Date ''Carrier Name. A,B,C-8) (xxxxx) podxx/x() (Format Varies) C8 782597 8/31/ STATE FUNDS B r FI�a - • 97 =•- ��,Ejfrx -.i • _� I- iI .4t? B 792225 3/31/03 EXEMPT z <. `r-,'• N/A sification I License No. Exp. Date ''Carrier Name. A,B,C-8) (xxxxx) podxx/x() (Format Varies) C8 782597 8/31/ STATE FUNDS B 792225 3/31/03 EXEMPT Policy Number Exp: Date' License No. )007595 1/1/03 -. 510 3/22/04 N/A N%A N/A N/A C8 782597 8/31/04 STATE FUNDS 4560007595 1/1/03. C36 759456 2/28/03 Employee Group 1640402 10/1/03 B 792225 3/31/03 EXEMPT N/A N/A B 792225 3/31/03. EXEMPT N/A -N/A C20 .749342 5/31/04 EXEMPT N/A N/A C10 631350 10/31 EXEMPT C39 676215737' ZrC>///03 5/31M N/A N/A N/A 0689177-01 STATE FUNDS Vs; u 6(0.3 �xs�t C15 591598 3/31/04 STATE FUNDS C17 737824 7/31/03. STATE FUNDS C20 .632072 9/30/03 TRAVELERS PROP C36 759456 2/28/03 Employee Group B 792225 3/31/03 EXEMPT 8 792225 3/31/03 EXEMPT C5 787248 11/30/02 Preferred Emplo ee B 792225 3/31/03 EXEMPT B 792225 3/31/03 EXEMPT c -61d03 -44e37_'$- 8/3/03 STATE FUNDS qr%.2 IS 510 , 3/22/04 N/A N/A �— N/A N/A 5951 1/31/03_ 2907 Z/ y' ° Arti.ek leocc 1641.715 7/10/03 1640402 10/1/03 ,v/A A N/A N/A N/A 0689177-01 3/3/03 4578 " 9/6/03 1- 146-001183 6/1/03 3085. 12/31/02 ©i�Q FC2TUB122 06/31/03 3291 8/25/0r 1640402 10/1/03. (08 4 Z D 3 N/A N/A N/A N/A N/A N/A 1640402 10/1/03 DN/A � 3009 N/A N/A N/A N/A N/A N/A 1576631 9/19/03 794 9 0/03 N/A N/A 5/8/03 ��-