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9710-0062 (BLDG) + 001307 (MECH)49725 Anacapa Cir 9710-062 001307 LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Ht Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N W Professionals Code, and my License is in full force and effect. O ch License # Lic. Class Exp. Date LO W ✓ f eJ o Z©ate ` Signature of Contractor cm 0 J U C) OWNER -BUILDER DECLARATION HLU r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's N License Law for the following reason: Z_ ( ) 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). M () I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner ON 0) 2< WORKER'S COMPENSATION DECLARATION p 2 Z I hereby affirm under penalty of perjury one of the following declarations: U-) O () 1 have and will maintain a certificate of consent to self -insure for workers' X w compensation, as provided for by Section 3700 of the Labor Code, for the O J Q performance of the work for which this permit is issued. Go Q I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this cl: H permit is issued. My workers' compensation insurance carrier &policy no. are: ,.* Z Carrier Policy No. ab 5CY < d J (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 370 of the Labor ode, I shall forthwith comply with those provisions. f Date: Applicants a Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. F 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant tod any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon s,t e above-mentioned property for inspection purposes. gnature (Owner/Agent) Date, BUILDING PERMIT DATE c, VALUATION e- ii i LOT PERMIT # CONTROL # TRACT G084 JOB SITE APN, ADDRESS v'h l« d1 V i1 -' !ilk ;i'; P4 i) ['.6 J ;7;; •, OWNER CONTRACTOR/DESIGNER/ENGINEER °AIS ,qui r'; ji$, USE OF PERMIT ,,,J$J,dlf =.Ai lA hL;kva-LYf >rbol'i;i',;.I ,01iew;'v'1 ;'O+ r4hazsjy:Ua,rq,' G f?9'';4`b't.2`vQi 'tAiC4 a0C i ; Mill11111111169 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 Wail Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath A fill Final Final BLOCKWALL PP OVALS ' POOLS - SPAS 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 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: PERMIT APPLICATION Q I]!.!!! 70 City of La Duinta Department of Building and Safety " This permit becomes void if work not commenced within 180 days from date of issuance. OR, if work has been suspended or abandoned for a period of 180 days. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I,am licensed'under provisions of Chapter 9 (commencing with Section 7000) of Divisien3 of the Business and Professions Code, and my license is in full force and effect. License Class Lic. Number Date • ' Contractor OWNER -BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to construct, alter, improve• demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more•than.five hundred dollars (S500.): 0 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 and Professions Code: The Contractor's License - Law does not apply to an owner of property who builds, or improves thereon, add who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or.Lmprovemnt is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or imp(ove for the purpose of sale.). ,_ 0 I, as owner ohthe property, am exculsively contracting with licensed contractors to construct the project (Sec: 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.).. 0 1 am exempt under Sec. B.,B P.C. (Attached. Certificate). Date Owner WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have'a certificate of consent to self -insure, or a certificate of Workers' Compensation Insurance , or a certified copy. thereof (Sec. 3800. Lab., C.). Policy No. Company O Certified copy is hereby furnished. - • Certified copy is filed with the City Building Inspection Department or City Department. Date Applicant APPLICANT NAME (L. F. MI) Folawn, s Heating R Air ADDRESS P.O. Boa 1849 CITY/COMMUNITY/STATE/ZIP Indiio�j , y��.��.9�220/17,�.,,,, JOB SITE AODRESS/SPACE 49--/25 LL1G�pa Circle - CITY/COMMUNITY/STATE/ZIP La Quanta, .CA 92253 BOK PAG PRC C TWN RNG SE- S• TRACT 1. LOT MOD SB - TRACT NAME OWNER NAME (L. F. MI) Carl, Misterlin CONTRACTOR -FIRM NAME y - + applicant ADDRESS above CITY/COMMUNITY/STATE/ZIP +�,�,,,' ' above PHONE a 347-6253 LICNC 0 350493 ' ARC/ENG FIRM NAME ADDRESS CITY/COMMUNITY/STATF/ZIP PHONE N LICNC M USE OF PERMIT - BL ZON FSB SSB SSB RSB OFC ZONE ORD M : , LOT SZ .. END - SIDE. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE: This section need not be completed if the permit is for one hundred (3100) o, 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. Date Applicant NOTICE TO APPLICANT:,If„after making this Certificate of Exemption, you should become subject to the Workers' .Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked.. DIVISION OF. INDUSTRIAL SAFETY PERMIT CERTIFICATION: 0(hereby certify tlial ndexcavatibn fi4e (5) or more feet in depth info which a person is required to descend, will be made in connection with work authorized by this permit, and that no building structure, scaffolding, falsework, or - demolition or disi iantfing thereof, will be more than thirty-six (36) feet high. (Chap 3.2, Grp 2. Art 2, Sec341; Title8, C.A.CJ — roti • 0 As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a permit to do such work from that division. .0 Division of Industrial Safety Permit No. Date Applicant CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, -Civ. C.). q Lender's Name Lender's Address I certify that I have read this application and state that the above information is correct. tagree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. ' Signature of Applicant or Agent Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify I have read this application and statethat the information given is correct. I agree to comply with all state laws and county ordinances relating to buidling construction, and authorize a'representative of the City of La Duinta Department of Building and Safety to enter upon the property for which I have applied for this permit for the purpose of making inspections. - Signature of Applicant or Agent Print Applicant/Agent Name Date APPLIPRMT nn 11. 1 n 3-28-85 / i� CIA/ . Parrot to install two 3 ton systems as per applicable codes and ordinances. Plan Check Jam/DU M.Anh.. Fee , 22.00 Plumbing Fee 12.00 -TOTAL FEE A 0 5 % I BLDG. DEPT. 1.4 3 Z VALUATION .'-08,0011.00 -. .6 NO. OPERATION DATE - ` INSPECTOR NO. OPERATION DATE INSPECTOR BUILDING APPROVALS. MECHANICAL APPROVALS 1 Set Back 33 Ventilation System 2 Ftgs & Frms 34 Plenums &-Ducts 2A Slab Grade 35 Furnace Compart. 3 Steel ti 36 Inlets &. Outlets 4 Grout Blocks 37 Combustion;Air 5 Bond Beams 38 Compressor. I 6 Roof Deck .39 Appl. ClearanceI 7 Framing 40 Fire Damper 8 Vents 41 Smoke Detection Device 9 Garage Fire Wall 42 Commercial Hood) 10 Fireplace P.L. ❑ 43 Final 10A fireplace T.O. ❑ NO ADDITIONAL INFORMATION SEWAGE SYSTEM SIZE & LOCATION 11 Exterior Lath 12 Internal Lath 12A Drywall 13 Finish Grade INSULATION Thick R value 7A Walls (Batts) 12B Ceiling (Batts) 12C Ceiling (Blown) 14 Final PLUMBING APPROVALS 15 Ground Plumb -------------- 16 Water Piping 17 Rough Plumb 18 Vents 19 Sewage.Disposal 20 Sewer 21 Water Heater 22 Water Softener 23 Water Service 24 Gas Test 25 Final Tank Pit L. Line E LECTR IC. APPROVALS REAR OF PROPERTY LINE P/L P/l STREET NAME 26 Power Pole 27 Conduit 28 Service Entrance 29 Wiring 29A Grounding Wire 29B Bonding 30 Fixtures 31 Service 32 Final