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Home My WebLink AboutELEC (0312-114)LICENSED CAN7RACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Swtion 706-0) of Division 3 of the Business and Professionals Code, and mp License is in full force and effect. License # Lic. Class Exp. Date war 1498 rya 1IL A Date �f�Sifna�ture of Contractor OWNER -BUILDER DECLARATION f 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 hdf" by 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. ( ) Dave 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 Si'AT r;,-40MITMIATI Policy No. M17412-03 (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 subjectrto the workers' compensation laws of California, and agree4at ifIt�sh�orrd�ecome subject to the workers' compensation provisions ofASectio Y37,0,of�the Libor Code, I shall forthwith cq�riply with those provisinc 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 la7lrelating to the building construction, and hereby authorize representative tKisc ity, to enter upon the above -mentioned property for inspection purpes '' Signature (Owner/Agent) ,r-.�'/t Date f � f� BUILDING PERMIT PERMIT# w 0312-114 DATE VALUATION LOT TRACT /t.1C, iK . $5100 D.00 JOB SITE c+ ADDRESS -i APN '1'l5�3'-i�ti't1i?S OWNER CONTRACTOR / DESIGNER / EN INEER CAJ.,W.E.Err RAW RcTi� Mo),T i0.T"-; Urf wwr P,O, 130X 06 KMA414, CA 93£30 (559)846-3326 Ci3I�# USE OF PERMIT z. 1:5 HI'.�k31'ft"Lti�'!fY AS, "41f4i#� Ia f' ,C :1 N+t .t f °�S,'f`im 1S VALUATION L °Jf A `E'L"� C t5 1' t3 air t ' :T iaas ,t ).€ 0 YERN , SUMMARY ((3�'`pp�yy'. p* ��-aa 33 ��+ ��yy //�� /dry �(� y p ;1 IILEM! RICIA L FE 'A01 "`4.�00-4#..M`�+TyJi:.0 „ " '��6100 P[:D:EC 11 2003 CITY OF LA CZ:1 N1A FINANCE DEPT. ar.'IUM-YCFTL11..• FivOX.dRY.JP.A..t,l/.191.CtiA'R'O PL" CL.MAX $2600 �3 Pik -ptiSi R $010' 45,ECEIPT DATE t BY-, DATE FINALED INSPECTOR NSPECTION R • OPERATION DATE INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings Slab -Grade Steel Roof Deck O.K. to Wrap Framing Insulation Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wall Firewall Exterior Lath Drvwall _ Int I ath OPERATION DATE INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Condensate Lines BLOCKWALL APPROVALS 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 ny�nai �cxa Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final utility ` �r�M�-rc-ti�avA7*1 6�t 3 3>11467, - -- -- 1 I / � ------------- L�o��)co 477)fZ.j_D, --- -- -- CT* 13A5E 5EE NOTE #5 - CalWest M Rain IrriQatinn Sarviaaa Pipelines Pumps Fnginee KERMAN CALIFORNIA 559--848-5328 TYICAL SERVICE: ; f3 zwfr.- 6/0 SCAM 11f=2' 75H P 460V 3PHA5E�ry4WIRE DRY I. a p«t aNlaut tl» a aorneid d CAL WEST MIN I� poN t.� ViwM oon4id v+Wi aiG �aila�tlorn tlra aoiNtlluM plm. wa..wae�io. aiM ot,n.a iewla�aia MIJIMM IF' 5 PA R KY FM JMI 03047 ti ASSESSOR'S PARCEL NUMBER 764-010-008 Printed 12/10/03 at 10:23 by v v i e r s m o CITY BOUNDARY/SPHERES 1 2 / 1 0 / 0 3 = AREA NOT IN A CITY SPHERE CITY OF LA 0 U I N T A 0 feet 500 1000 1" = 510 APPROXIMATE SCALE This map was made by the Riverside County Geographic Inlormalion System. The mop elements vere produced yy the Ass'e;ssor and the Tronsporl0tion and land Management Agency which is comprised al the Administration and Inlormalion Resources divisions and the Building r< Safely, Planning and Transportation departments. The Caunly of Riverside assumes no warranty or legal responsibility Tor the information contained on this map. Oola and information represented on Ihis map is subl'ecI to update and modification. The Geographic Inlormalion system and other sources should be queried for the mosl currenl information. OF Rr�f COU;TY OF RIVERSIDE J2 Ri9� Depar . nt of Building and Safety y 4 B �LDING PERMPT god sere This permit shall a 're by limitation and become nul ,,a, void if work is not commenced and a written uest for inspection filed within 180 days from the date of issu e or if work has been suspe ";'!orVabandoned for a period of 180 days between e filing of written requests for inspection. ❑ LICENSED CONTIACTORS DECLA". Chapter 9 (commencing "' th Section 7000) License Class �1 Lice] o. I hereby affirm under penalty of per'/ryry that I am licensed under provisions of n 3 of the Business and Professionode, and my license is in full force and effect. Date Contract N ❑ OWNER -BUILDER DEC, RA I hereby affirm under penalty of per" that I am exempt from the Contractors Life i aw for the following reason (Sec. 70 ess and Professions Code: Any city o ounty which requires a permit to construct, alter; improve, demolish or repair any structure, pi`; its issuance, also requires the apphc for such permit to file a signed statement,fiat<heor she is licensed _pursuant to the provisions o ;Contractors License Law (Chapter 9 mmencing with Section 7000] of Division�3 ofthe Business and Professions Code) or that he or exempt therefrom and the basis for a alleged exemption. Anyy violation of Seer17031.5 by any applicant for a permit subjects the Y;'' nt to a civil penalty of not more an five hundred dollars [$500].): ❑ I, as owner of the propert °my ployees with wages as their a compensation, will do the work, and#ie structure is not intended or offered for sale (Sec. 70usm and Professions Code: Contractors License Law does not appal', Ito the owner of property who builds or improves th regn, and does such work him or herself or through his or her own,emp�oyees, provided that such improvements are not int d or offer for sale. If, howeve e building or improvement is sold wVAin one year of completion, the owner -builder will have J" urden of pr in that he or she;' d not build or improve for the purpos&of sale.). ❑ I as owner of the pr am exclu ly contracting tth licensed contractors to construct Ile project (Sec. 7044, Business and Professions Code: Th 'ntractors Licen Law does n -,, apply to an owner of property who builds or improves thereon, and who contracts for such pro '"with a contracto licensed p rsuant to the Contractors License La ❑ lam exempt undec. B.&P. r this r on.: r Date wrier " r. WORKERS CO SATION DECLARATI I hereby affirm under penalty of perjbi y,'Mne of the following declarations: ❑ I have and wil ntain a certificate of consetl elf -insure for workers compensation, as provided for by Section 370 of the Labor. Code for the er �ince of the work for whicl�thi .w rmit is issued. q' ❑ I jlave andpw' aintain workers comppens ton in ance, as required by SectloVC8700 of the Labor Code, for. the performance of the work for whi his permit is issued. My;:" orkers e, pensation insurance cairxe�r and policy number are: Carrier Policy N er �.° (This section need not be completed if the permit is for one hundre ollars or ess . g `, ❑ I certify that in the per ormance oft ork for which permit is iss�u , shall not employ any person in any manner so as -to become subject to the workers compens, on laws of Californ and aggree tha I should become subject to the workers compensation provisions of Section 3700 of the Labo ode, I shall forthwit ,A mply witl�iose provisions. WARNING: FAILURE TO SECU WORKERS COMPENSATI VERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PEN TIES AND CIVIL FINES U e' ` NE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF C. MPENSATION, DAMAGES PR, DED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS; EES. fit, CONSTRUCTION LENDIN AGENCY: I hereby affirm u altv of p 'ury that there is a construction lending agency for the performance of the work for ich this permit is issued (Sec. 3 Lender's Name d Lender's Address F' CERTIFICATE OF C LIANCE AND AUTHOR ION OF ENTRY: I cert _ hat I have read this application and state that the above information is correct. I agree to comply wit ounty ordinances and state la elating to building construction, and hereby authorize representat' of this county to enter upon t ove-mentioned property for insp' tion purposes. or Date INSPECTION FORMATION: Work may proceed only at the direction of the field inspector. To request inspection of work completed, call the appropriate a listed berowUu_r office hours are 8:00 a.m. to 5:00 p.m., Monday through Friday. �. West C unty: Riverside Office 909 955-1800 South County: South County Office (909?6100 East unty: Indio Office (760� 863-8271 !. REINSP CTION FEE: Reinspection fees maybe assessed when the permit card is not properly posted on the work site, e,approved plans are not readily avai a e to the inspector, for failure to provide access on the date for which the inspection is requested, or for deviating from,plans requiring approval of the Building Official. A reinspection fee may be assessed for each inspection or remspection when such portion of work for, which inspection is called is not complete or when corrections previously called for are not made. OCCUPANCY: Buildings or structures shall not be used or occupied until the Building Official has issued a Certificate of Ocancy (or for residential we ig�ign-off ofthe final inspection on the job card by the building inspector). 284-208 (09/99) A ------------ -mix " N t6 ... - - ------