RPL (0002-018)52510 Avenida Madero
0002-018
-' LICENSED CONTRACTOR DECLARATION
"'I hereby affirm.under penalty of perjury that I am licensed under provisions of
Fes- Chapter 9 (commencing with Sectio6•7000) of Division 3 of the Business and
N W r M'lessib ials Code, and my License is in full force and effect.
0 License # Lic. Class Exp. Date
O ` ' ®5x1:28 G 53 vr '"^";1,iV3 q20(
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Z YDate 3 Signature of Contractor'" ` -' t
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' 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 theirsole
compensation, will do the work, and the structure is not intended or offered for
- sale (Sec. 7044; Business.& Professionals Code)., -1, . - ;'
( •) •I, as. owner of the property, am exclusively contracting with licensed
, contractors to construct the project -,(Sec. 7044, Business & Professiorials
Code). .a' - r. .7 .
I am exempt under Section B&P.C. forthis reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the 'following declarations:
have and will maintain a certificate of consent to -self -insure for workers'
compensation,`as provided.for by Section 3700 of the •Lebor Code, for the
performance of the'wo_ rk for.which this permit is issued.
( ,) I have and will maintain workers' compensation insurance, as equired'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.'
S'l N116 FtJN1 ` - 43f-Ct•^, G"f}n6aGt,-3'
(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.pelrson in any, manner so as to become subject to the;..
workers' compensation laws ofjCalif6rnnia,,and agree that •if,1 should become
subject to the workers' compensation provisions of Section 3700 of. the Labor
Code I shalllforthwith comply with those provisions.
Date '71Z 1 !iJ Applicant . t V.
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 iri,Section 3706
of the Labor Code, interest and attorney's fees. a
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: 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.t • +
5
Signature (Owner/Agent)\ " 'f ,j Date G e
PERMITN
BUILDING PERMIT S .
:
DATE } VALUATIONT li .a LOT 9 TRACT-, 67 U9 7
ADDRESS
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OWNER
CONTRACTOR/DESIGNER/ENGINEER
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I SANTO UOAf;NG0.Cil
'74-725 ;Ft l bRIVl , VA j
MIN ►V1fkA_GE' CA 92170
.1't1.i.M bFSiwXF ' CA 92260
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USE OF PERMIT
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PLAN 01-JECK FEL 1.01-000.439-315
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DUE NWAV
RECEIPT
DATE t BY" •..
DATE FIN ALED
INSPECTOR ,
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INSPECTION RECORD
— OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR -
BUILDING APPROVALS
MECHANICAL APPROVALS
SL*t 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
A
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)