Loading...
BLDG (0004-188)54530 Avenida Madero 0004-188 I LICENSED CONTRACTOR DECLARATION j{ 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 Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date l 522795 AJ13MC 12/3)/21( Date 4j / OBJ Signature of Contractor— OWNER-BUILDER ontractor 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 FitEMONT Policy No. WW.09802M-02 (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 sfbject to the workers' compensation provisions of Section 700 of the Labor ode, I shall forthwith comply with those provisions. (Date: Ct -19_ A Applicant - p V Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $1,00,000, 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 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 ,puurrposef Signature (Owner/Agent) - +' / Yi©ate%✓ I BUILDING PERMIT PERMIT# DATE VALUATION LOT 0004-188 TRACT 04/18t20C $5,700.00 23 BL.K2 f 2 `[125 JOB SITE APN ADDRESS 54— AVENl A Ma MMO r OWNER CONTRACTOR / DESIGNER / EN (NEER JOE. MARIA AVIi.,A. JA[v1M E SWO14 Co. . ..1 PO BOX 1155 F O BOX 10M R"CHO MI AM OA 92270 M10 CA 92202" r r (760)347.5399 CLT 01211.. . USE OF PERMIT C3F. +ii ;.AT., UII.I a?'TC = . f "• , BLOC:K.180,41P. ra 6' HICfH &7147 4'H1011 s f FF, WALL IKOO 11 4 FT. WAIL :15.00 LP' XMIMATED COS` OF CONSTRUCTION `TC(.?N 5,700.00 PRRb r Fes: 911 JAF!l4fARY CONSTRUCTI(YN FEE 101.000-418.000 Sf31.0O SUB-TOTIAL CON8'[ iRUC4TION AND PIAN MY—% $81.00 L&S3 PRE-PATMERS $0.00 A RECEIPT DATE y } V_ ./ D Tft IN (/ INSPECTOR I 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 BLOCKWALL APPROVALS POOLS - SPAS steel Set BacksElectric Footings d s Bond Main Drain Bond Beam ,-t ,.p G am Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final p, y o Soo,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: j w 1 Bin s City of La Quinta Building BE Safety Division P.O. Box 1504 Permit # 78-495 Calle Tampico La Quinta, CA 92253 IxIo - Building Permit Application and Tracking Sheet Project Address: - S30 6, C4,1 Owner's Name: 1/ ,``£ t m"I r-.A t A. P. Number: -M— 19o- o Z Address: V Leual Description: LI- ,) ' City.ST. Zip: p clv C o O 9.470 Contractor: v Telephone: 3J q - 6 o ? Address: 5' - 3 -S U 71 7 Project Description: NO I j c Citv.ST. Zip: q2 2 Telephone: 3 State Lic. = : S17 IS City Lic. #: Arch.. En_r.. Desismer: Address: Cite. ST. Zip: Telephone: '7 J ,. 0-) 1 Construction Type: B Occupancy: State Lic. _: j J— Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: S- C Sq. Ft : 7 # Stories: # Units: Telephone = of Contact Person: 30 - - Estimated Value of Project: APPuh^.AN?c'Oo : [iiOT'E':IBEL DYITHGS:hiE r Submittal Req'd Reeld TBAC IG': PER1HTEi ST Plan Sots ;.- P3aasledtsn6miaed::,. _` 31'em •:: :.:.Amount, Structural Calm Truss Calcs. Ca1kd:Casstact:Penas.<. :..: Piac;(3eek:Balaace Title Zd Calts: Plaas:pielied< ` Cane6nas 'i Grant Deed Plaacsrsttifimitsted Medtamtat School Fea ::: Revit trsd Bead tu:ata4 Rieatict! Sobeentacter>tist :Cosstsct Ptssrtm::: Piumbio Coutrattorinfo .::... Dttta:aE.pstttaitIme :' ' 5 Cir Business Lic. ... Cs O .. Workers' COMP..:.' :. lrasteaetae r 3 '» ?` Planning Appravtl A.,P> :c:;.•:.•;::; Pub.lYks..Appr .. Appro::::... Fire Mar. A . PPr IlL Dept. Appreval ::.. _ :. .. .. Ag. Approval:": ::. ;: Dite:af i:iwpet ioe.....: `.. ?ataf ertnitlFees ....::: ;: