Loading...
BLDG (9712-102) + RR (12134)54775 Avenida Madero 9712-102 12134 LICENSED CONTRACTOR DECLARATION .I her 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 % a. t.+54 ? C39 s13i19 ie Signature of Contractor 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 Sianature 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. t ( ) 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: Cartier + R + Policy No. w !A ATE.CU,',fl F ­#- r).% !r (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 3700 of the Labor Code, I shall forthwith comply with those provisions. Pate: Applicant 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. 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. Signature (Owner/Agent) Date PERMIT # CONTROL # BUILDING PERMIT 9712-102 DATE I'M2197.-VALUATION s ry G / a1 L+ LOT TRACT6626 JOB SITE DDR SS 74-775 ,C 6' ENXID 5, MADE, R.O 7 OWNER CONTRACTOR/DESIGNER/ENGINEER I'll OLI P1,11, w",' 's,^ i.'lC; `: . .} - is Fa., SJR. ,d WS.rA AT N1'1I.,iI- .r. S0NS air ►r.It (3 PIDBOX 15915 b8760 SI;JiEIN41T.' DRIVE LA QUANTA CA, 92',"93 • C A',f'f[E:l.) UXL(_TrY t\ 922-1-1 760)3284406 CRI,{ 100 USE OF PERMIT 1`3L +fit., I,Jt'L++c; • TZO4.Oid.x Lta+.i`3 4.tdil s: rrs1-+..4„+ a.s, OF CONNT 9 .0 slOP*4 S.'70.tufl 1'F;.1041T F.0 F, SifAfJWAiIY to l -fiO4-418-000 W C3 V Q W LLJz LL. . .,4 „. , . 1 .10 -,Oyyl.L fp RUlrY f 1 PLANl1lif\X S3.10-TOTAL p!. nq LESSr-RIS -€SAID PES TMA1. MR411'1' 1' + S' 0t)K i`t01V §3Q) ltt4 RECEIPT DATEBY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 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 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - I t. Lath oo Final Final BLOCKWALL APPROVALS 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 -: Tem . Use of Power r Final Utility Notice (Perm) COMMENTS: . 44a P.O. BOX 1504 N o . Building 78-105 CALLE ESTADO Address 54-775 Madera LA QUINTA, CALIFORNIA 92253 Owner . . Robert & _Ardyth Hamilton' Mailing BUILDING: TYPE CONST. OCC. GRP.; Address pyo. BOX 15!)3 ' A.P. Number City,Zip Tel. La Ouinta, CP, l92253 .564-4170 Contractor Owner Address, City lZip Tela State Lic. I City B Classif. Lic. # Arch:, Engr., Designer Address Tel. City I Zip I State Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city orcountywhich requires a permit to construct, alter, improve, demolish, or repair any structure, I prior to its issuance also requires the applicant for such permit to rile a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or 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 sub'ects the applicant to a civil penalty of not more than five hundred dollars ($500). [has 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, Buisness and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon and 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 improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) D 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct 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.) D 1 am eexxempt under Sec'. . & P.C. R11thi,6re. a_son /D`aIa Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company D Copy is filed with the city. -,D Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation 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. Date Owner NOTICE TO APPLICANT. If, after making this Certificate or 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. 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, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant €_ Date Mailing Address City, State, Zip 121.34 " Legal Description Project Description Extend .roof 511 long -by 4' Sq. Ft. Size. New ❑ No. No. Dw.. Stories Units Add ❑ Alter ❑ Repair ❑ Demolition ❑, stimated Valuation $2,992.00 PERMIT ; AMOUNT Plan Chk. Dep. BY: Plan Chk. Bal. Distances: Const. 54.00 Mech. Rear Setback from Rear Prop. Line Electrical Plumbing S.M.l. .30 Grading INSPECTOR Driveway Enc. Date Permit Infrastructure Validated by: . AA s 42 r TOTAL '54. 30 REMARKS { w d ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADEROUGH }a C� BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. ® FORMS �It SEWER OR SEPTIC TANK ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® GAS (ROUGH) METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING ; CARP. SQ. FT. ® GROUT WATER HEATER WALL SO. FT. FINAL INSP. DRINKING FOUNTAIN. SQ FT ® WATER SYSTEM URINAL ESTIMATED CONSTRUCTION VALUATION $ , =$ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.000L HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED VENTILATION LAUNDRY TRAY AIR HANDLING UNIT CFM FIRE ZONE ROOFING KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE, TEM/PERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SQ. FT. ® c BATH TUB LATHING SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE / PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADEROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS �It SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ , =$ LUMBER GR. FINAL INSP. FRAMING 7.,� —� `� FINAL INSP. ROOFING '� �� 3 (� REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL Robert W. &FArdyth J. Hamilton 54775 Xvenida Madero La Quinta, Ca.