Loading...
9912-0008 (SFD) f:J LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT# I hereby affirm under penalty of perjury that I am licensed under provisions ofi (b�iti 1.2- -A• Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE � � VALUATION $�'�$, �,.A4� LOT S TRACT - 287V cv W Professionals Code,and m License is in full force and effect. License# y Lic.Class Exp.Date + �� L 690645 � W13012-(i AJOB DDRESS m40�W APN 769460-008 LU r Z /ate /.) r r Signature of Contractor �� OWNER CONTRACTOR/DESIGNER/ENGINEER O J U OWNER-BUILDER DECLARATION P.0 BOX 811) 1425 E.i11`11V.i &SffY ORIV1? H LLI I hereby affirm under penalty of perjury that I am exempt from the Contractor's '�.� ��� PT�C?tsNIX X Z X9)34 U) License Law for the following reason: ft Z_ . ( ) .I, as owner of the property, or my employees with wages as their sole (b�?2�92.4;'IfSS R ' 491)0 compensation,will do the work, and the structure is not intended or offered for sale(Sec.7044,Business&Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed At�l. �J �1„l. it contractors to construct the project (Sec. 7044, Business & Professionals Code). Sr-0-LOT 3,A,A ;fit R Mum(IT DOES NOT L=UDfW QC'1e:�5i}ALL OR C'•) O I am exempt under Section , B&P.C.for this reason ter ) I ,�,t] ] i]'t -i`�q ty .. N - P100..�`.k'W��.;TO.L7�'�7 l'`A:.Lttr11��-:J�Y,�t�+� ti.l,F.:i'xr C}.Rs f�i�j,7�LAN-':4:�'.C".ls•).- . O N Date Signature of Owner rn ' Z WORKER'S COMPENSATION DECLARATION C) 2 Z I hereby affirm under penalty of perjury one of the following declarations: � Q CITIS'!0M.C.'Cy2�i,4"�1 U%7110114- S;i.{M!3 O ( ) 1 have and maintain a certificate of consent to self-insure-for workers' X W u- compensation, as provided for by Section 3700 of the Labor Code, for the I'O R(I ivPX1,10 7031,00 SF Oro J Q performance of the work for which this permit is issued. Gh� R.AIY&C;AI;tF't)W)' 582.(%)S Q U (!Q I have and will maintain workers'compensation insurance,as required by Q U Q Section 3700 of the Labor Code, for the performance of the work for which this 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrierr Policy No. w a� s CO3*Nt lt•,1LN or If. WIM1.'7004 1.0M d Q (This section need not be completed if.the permit valuation is for$100,00 or less). �� ' iH iLgL`S'd)14 �►t�' J ( ) I certify that in the performance of the work for which this permit is issued, C:Ol+fS11lZi t;f'lG�IK"rTE 1(?.! 0(20-4 $-LJC){) 3Si,t>i«.4XJ I shall not employ any person in any manner so as to become subject to the PLAN f.`•RF(,TC'T'fw'E' 1.0!fi0439-:31R 9W.87 � 1 workers'-"compensation laws of California, and agree that if I should become I �rrt 9 P��.:CI,_AtsiC,.1L�� iED. {?(�U-�.��-t?tif3 �ti�.�tt ,•� ; E• . sub��'ect to the workers'.compensation prori6hs� ection 3700 of the Labor .� :32TCA. I 1l�4-s3 -X20-t��x"e $I4y,;{4 3 C1. de, I shall fbrthwio comply with those,.prov sio yuate:, /�!.•1 f'� Applicant— �-� ft1.Al�ili�t�r.FEE .._• STRONG tvf(3'3'F.oN FFF-RESH') 101-000-24!-W) $21.49 �t 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 0111iT3ITbQ FEE 1, 1- S20.0 `—' addition to the cost of compensation,damages as provided for in Section 3706 T➢i3V1:f.OPER.IMPA.C'.P FEE S11,907106 t J of the Labor Code,interest and attorney's fees. ART€'N]RU8.0C;F%ACES-T�'.ESPO 71)1.••000.255-(}E?('r S?>C7.Id 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 S a P1 t , a. ., * K. any permit issued as a result of this applicaton agrees to, &shall, indemnify `UB-1W'!`���•�-NSIN IC I��)� � � �' &hold harmless the City of La Quinta, its officers, agents and employees. LE&S' PRE-t A11)1'EE,:>3 `��• � 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 TOTAL A�I'f4'.i�U*FEES DUF NOW' S4,386.84 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 IIIIIIIIIIIIIIIIIIIIIIIII • correct. I agree to comply with all City, and State laws relating to the building {'' 73 construction, and hereby authorize representatives of this City to enter upon z t IE th atiobove-mentioned property for inspecurposes. i / RECEIPT DATE BY DA F ALE INSPECTOR ' ✓Signature (Owner/AgentDate 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 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 Pool Cover Sewer Connection 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 Utility Notice(Perm) FAX N0. 7605642238 Feb. 07 2001 09:02RM P1 ' IIIIIIIIIIII I II VIII 76 - r :,u,;,,:._.,•:...,,. .. :.:.. .::<.. .'.. , ,4 IE skis CITY OFIA QUINTA I oea I3Wi PINgWt FETY DEPARTMENT i= 777=7012 i� INS ff ECTION`REQUEST LINE ` I. DEC U j .777.7153 <if . ContractoTNC r Permit Number_ 9912-00$ _' ; r;1 :l =+w• .w . POST ON JOB IN CONSPICUOUS PLACE ' ( INSPECTOR MUST SIGN ALL APPLICABLE SPACESI JOB ADDRESS. 79-440,AZAHAR SFO-LOT 5,PLAN ZBR PERMIT DOES NOT INCLUDE BLOCK WALL OR POOL. TYPE OF INSPECTION DATE INSP. i FOUNDATION&SETBACK r FOOTING STEEL f�?} MAIN GROUND SYSTEM GROUND PLUMBING PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED +' CONCRETE SLAB JOISTS&GIRDERS ELECTRICAL GROUND WORK 1i r i D, ,.IDT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED ROUGH ELECTRIC ROUGH PLUMBING ROUGH GAS&GAS TEST �i HEATING&VENT-A/C FIREPLACE ROOF 1i BOND BEAM j i! O.K. TO WRAP - e GROUT O 4' ❑ 8' FRAMING INSULATIONS PRE-ROOF COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR -�fl• ©>f Qt^ ;IkJ`i EXTERIOR LATH `7 P00h,PRE PLASTER r ' ,L ENCS 8 DATE E SEPTIC TANKI"� itq FINALS ELECTRICALfI PLUMBING FI"'AL GAS TEST ilkl _ :'I NG-AIC 1 AWSE NUMBERS JOB COMPLETED �I TEMP POWER ++ Ii iy� ABOVE APPROVALS DO NOT INCLUDE RIGHT TO •r!IG W YIN I rm mr-4t no rv:nt iov Ri m mum