Loading...
SFD (9907-006)U) N U) W o =) c+) d ' W C:) Z � 0 0 HCD J P ~ a Z . LICENSED CONTRACTOR DECLARATION �I liereby 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 # Lic. Class Exp. Date 674074 '8t \/D e { "! Signature of Cont ctor r 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 t6"property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). f () 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: O I have and will maintain a certificate of consent to self insure for workers' compensation;,+as providedyfoe'by Section 3700 'of the Labor Code, for the performance of the work for which this permit is issued. ( ),j 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. . . of A. I9.4 iL✓, .T U.�V#.d f�^f�-l,��NJ t>�i! (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 hould become subject to the workers' compensation p visions of Section 3700 of the Labor CpdeA shall.forthwith comply with those provisions'. Date: �rf' Applicant— Warning: Failure to secure Workers' Compensation coverage is unlawful nd 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 fo 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 inspect of n purposes Signature (Owne'r gent)' Date{li/YM� i AitA0\ , BUILDING PERMIT PERMIT DATE VALUATION LOT TRACT ;�2i►4.9� 7.21i 289.12. �t>IF JOB SITE 11�� t ADDRESS. 4,Q% M4, AIONI.+�l,N� ���2��' APN 649-2.10-067 OWNER,CONTRACTOR/DESIGNER/ENGINEER -1,T) 9 t '>i IS F R 11' $PAR'; $ r.'.:f )NSaIR IC"I IGTN Tau b l?iU 7.9-295 RANCHO LA. QUINI 't"A ML .: A 001 KCA ' GA 92253 i. A QUN, IA C;.A 9Z253 41 USE OF PERMIT _ SMU-'I.v14 6 r'LA14 iii i WALL OR POOL, CU i`ONI CON&:k'R:U T 6ON 3,070,00 Sr 880.00 Sr. (JAi2.Rit3f+.:WCARPORX 693.0 SF �1•y�7!'�F.111Y1�A.R�.,l1r �. Nas)d �1 �,t'Il�i. il.O l��'k•Y�dl �v 4C!(3i�'D�.LIY yy,;MN( EF M' CONSTI2UC7.$01ti FIRE" 101-tlii O.418400 S1.743.00 Nuc HAMCAL K -E. $124.0 VLUIv T31 NO F .6 101-000-40-000 y-000 $183.00 STRONG N OTrON FEE, -RFS.t'3 101 -WO -241-000 S^ C),49 GRAL)ING 'fa"IC h 101•-000.423-000 $12M00 INVIRL&SWAMTURl: FEE 225 -W -44,M4-2 $3,401.07 ' 64,tiT IN FSYfLM,.1'C.11LACES - I2,1 su /01-,000-25_5-000 SUB-TUFA:11 c,;CiN','zrTRU(;!'i0N f11`q�Tpp��_(P��<<.��N©(�fyiECe,.K Fr S. MOO ,r `^vz art " f „ d` ;.. �'691.':?lL i',dl%3;�ltl+i�':I± S:��J4+:141')1V t M F ,yy K.n;wy f: RECEIPT DATE BY�� 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 p- Exhaust Fans O. K. to Wrap _0449F.A.U. Framing Compressor %- Insulation GC/ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final cam - 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 I I 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 t7--12; 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)