Loading...
BLDG (9807-284)LICENSED CONTRACTOR DECLARATION U) I hereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and N W Professionals Code, and my License is in full force and effect. O M License # Lic. Classi Exp. Date d LO } oZ � t/bate / �' "M Signature of Coritractor- cc)O� J U � OWNER -BUILDER DECLARATION Huta I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z_ ( ) 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). ce) () I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner r O rn Q WORKER'S COMPENSATION DECLARATION C) 2 Z I hereby affirm under penalty of perjury one of the following declarations: Lo O () 1 have and will maintain a certificate of consent to self -insure for workers' X W �= compensation, as provided for by Section 3700 of the Labor Code, for the O J Q pe ormance of the work for which this permit is issued. m Q C) % ^ I have and will maintain workers' compensation insurance, as required by O U QSection 3700 of the Labor Code, for the performance of the work for which this Ii rn H permit is issued. My workers' compensation insurance carrier & policy no. are: ,It Z Carrier Policy No. ob O VAIMs 1111,101 1017295'17 J (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 1 subject to the workers' compensation provisions of Section 3700 of the Labor e�•i7 Code, I shall forthwith comply with those'provisions;i /Date:'7 i *f ' � Applicant Warning: Failure to secure Workers' Compensation coverage its 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.insp6tion purposes. nature (Owner/Agent)) -5/- " ` Date PERMIT# CONTROL ��- BUILDING PERMIT I/ 9X417-2t6S DATE 71M198 VALUATION - $4,876.'11 LOT TRACT 2 6 / 7 JOB SITE ADDRESS 51-.1137 AVi+.1 IDA R�I",i`�II)OZA / G V OWNER.CONTRACTOR/DESIGNER/ENGINEER CE01t',f0 iiRI' taig/: r0MIVA,i-t 110 PADX _3 16 734 W11,LIAMS ROAD LA(,iAKI-A CA 9`253 PAIA1 SPRINGS CA ')2264 (76ff)3:7-$W Clt1':fr 18'25 USE OF PERMIT 4:i1:NhkAL (31J1l.l.i1N';r ltva'i�at.4, At.1Jt4{1A+`Ut:a1J EttiA 1C.1 �.��.e!;S:ti. Sf7 �.�. fc:liC.ifi ;e,2[E' 110R f VIIVIR1 5 1-1 00 Fill PL AN +'iiF(X I E 541 +'�r�rut'szrt�•�'}r�t+fl�f;}'s 1{1!-fifNi-.211;-fl(1P i!Na�N1 i`CttFr�{:�'NKYVIO.J i•'i:li - RE',W1D lot-WO-2=41-0DO • 'r a ri S(itt.l't)'j AI, CON i+"!RU(TON AN 1.) PLAN C1{t C14 �,}.}4 f �► 't'!Yd<AL PERMIT F CEKS 01111 , NOW $449,144 RECEIPT ff AT 'u 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 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 1A 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 Temp. Use of Power Final iltility Notice (Perm) COMMENTS: i _. T4'ht 4 4 Q" Building 51—$3 7' Ave. Mendoza Address Owner George ®. Hart P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Mailing Address P.0. Box 516 City Zip Tel. La Quinta, CA 32253 564- 4334 flactor Jf ner/Bt:i113e;r p State Lic. I City & Classif. Lic. # Arch., Engr., ..'Designer Address Tel. City(Zip I State Lic'. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) t.of Division 3 of the Business and Professions Code, and my license is in full force and effec SIGNATURE DATE OWNER-BUILOER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: -(Sec. 7031.5,Business and Professions Code: Any city or county, which requires' a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the_ Contractor's License Law, Chapter 9 (commencing with Section 7000) of "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 subects the applicant to a civil penalty of not more than five hundred dollars ($500). 01 , 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, 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 bund or knprove for the purpose of sale.) ❑ I, 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.) ❑ 1 am exempt under Sec. B. & P.C. for this reason Date 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 ❑ Copy is filed with the city. ❑ 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 thip work for which this permit is issued, I shall not employ any parson in any manner so as to become subject to the Workers' Compensation Laws of California. Dale Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation' provisions of the Labor Code, -you must forthwith comply with such provisions or this permif shall be deemed revoked. WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGEIS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. This is a building permit when properly filled out, signed and validated, and is subject to expiration it 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 No. 14345 BUILDING: TYPE CONST. • OCC. GRP. Number Legal Description Project Description Gat age Addition 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 !P1 rmit Validated by: I Validation: I Nf1V n R lggA. QV Sq. Ft. 5208 • Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $10,348.00 1 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. 81.30 Const. 126.00 Mech. Electrical 33-48 Plumbing t n S.M.I. X.9 .: Grading Driveway Enc. ' Infrastructure TOTAL 'REMARKS 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 !P1 rmit Validated by: I Validation: I Nf1V n R lggA. QV CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBIW FEES 1ST FL. SO. FT. @ $ UNITS COLL. AREA 2ND FL. SO. FT. YARD SPKLR SYSTEM POR. SO. FT. @ MOBILEHOME SVC. BAR SINK GAR. SO. FT. @ POWER OUTLET ROOF DRAINS CAR P. I SO. FT. @ DUCT WORK DRAINAGE PIPING WALL SO. FT. @ DRINKING FOUNTAIN SO. FT. @ HEATING (FINAL) URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GRADING cu. yd. $ plus x$ LAUNDRYTRAY AIR HANDLING UNIT CFM 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. SO. FT. @ c BATH TUB SO. FT. @ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 11/4 c SEWAGE DISPOSAL FIREPLACE SO.FT.GAR @ 3/<c HOUSE SEWER SPARK ARRESTOR GAS PIPING PERMIT FEE ERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE rPLCK 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 GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. 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 / Q ��/�'7 r FINAL INSP. ROOFING jjl �! REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING 1 MESH INSULATION/SOUND FINISH GRADING /. FINAL INSPECTION !y u CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL T a 4ht 4 �WQ�tw P.O. BOX 1504 Building 51-837 Ave. Hendolcia 78-105 CALLE ESTADO Address LA QUINTA, CALIFORNIA 92253 Owner Geflrge & Georgie Hart Mailing Address P.O. Box 516 City Zip Tel. La Quinta, Ca 92253 1 564--4334 C049V8ia Plumbing Ad3dress 8675 Los Cerritos City Zip Tela Bermuda Duties, Ca 92201 345-6300 State Lic. City &Classif. 335702 Lic.# 706 Hrcn., tngr., Designer Address Tel. CityI Zip I State I 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 Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions or the Contractor's License Law, Chapter 9 (commencing with Section 7000) of 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 subjects the applicant to a civil penalty of not more than five hundred dollars ($500). Igtsuas owner of the property, or my employees with wages as their sole compensation, will he 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 or proving that he did not build or improve for the purpose of sale.) Yas 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec. B. & P.C. for this reason 'Date L 00✓Owner "'t�­f .r 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 ❑ Copy is filed with the city. ❑ 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 of 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 Ihereby 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 ateMailing Address City, State, Zip BUILDING: TYPE CONST .P. Number No. 13659 fi OCC: GRP. Legal Description Project Description Sewer Connect Sq. Ft. Size No. Stories New ❑ Add ❑ Alter ❑ No. Dw. Units Repair ❑ Itstlmateo valuation $110100.00 Demolition ❑ PERMIT - AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 30.01 .S.M.I. Issued by: Grading Driveway Enc. I Infrastructure TOTAL 30. OU REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side SetbAk-from Property Line FINAL DATE J 4NgPf;r q 1 J 1,41 1 Z)`, Issued by: u Date Permit j ?V I Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. ® $ UNITS SLAB GRADE -A BONDING YARD SPKLR SYSTEM 2ND FL. SQ. FT. FORMS SEWER ROUGH WIRING MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® GAS (ROUGH) METER LOOP JAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. I SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN SO. 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.COOL 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. SO. 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 FINISH GRADING 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 GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER ROUGH WIRING DUCTWORK ROCKSTORAGE 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 FINAL INSP. ROOFING REMARKS: VENTILATION FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION a3 A < CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL .r Received Address: Accountl' Service Ai ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House Laterals) ❑ Detector Check (a) ❑ McSpfSurcharge GG Sanitation Capacity Charge V ❑ W.S.B.F.C. ❑ Temporary Construction Meter ❑ Turn on Charge ❑ Uncollected Account - Name ❑ Inspection Fee - Tract - Fee - 0 Plan Check Fees Water 1 Sewer - Tract - ❑ Bond Payment - A.D. - Bond Assmt. ❑ Customer Deposit ❑ Other ` Remarks: 4 t' ❑Copy to: Cash Check 7. Money Order HE A*6F1t $ j TOTAL Water Service Cashier_ CVWD-438 (11189)