Loading...
0012-225 (PLBG)LICENSED CONTRACTOR DECLARATION 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 68456.3 AB A`343 LJ( i.)Signature of Contractor OWNER -BUILDER DECLARA7 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. Si( )' I have and will maintain workers' compensation insurance, as required by 6ion 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 STATE FUND Policy No. 044-00.0014224 BUILDING PERMIT DATE VALUATION LOT JOB SITE ADDRESS 53-5ft AVK147DA RU BIO ,, IOWNER (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 worker (compensation laws of Cal'ifornfa, and agree that if I should become subject to the workers' compensation provisions offSection 3700 of the Labor C ode I shall forthwith comply witfithose provisioris. � �0r ' 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�l 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'. i 'Signature (Owner/Agen't), ' "�� A •�- ���' � Date . 1 -D Ivi& A1'7I) mRs. m..IC7Aid o k3l "ii/ 53.585 AVE ?A RUBIO LA.QU;; TA CA 92253 USE OF PERMIT PERMIT# iCRACT APN 774-1.12-015 CONTRACTOR/DESIGNER/ENGINEER 68.175 DFAR08 rO*UT..0 CAr"rMRAL CTrY CA 92234 (760)327.2.200 C BI,# 3577 SEPTIC: ABANDON. SEWER.CONNEC:C. 1,117W -M01) Pk'C?.fTCC T M-.111. VAUTATIC V114 I'm" !A E917MJ►M COOT" OF C0141".i'ItIU'C"I'A7N1*90DWI' PERikll:i Mm a R PLUMBINO IBX -- SEWER10i-MID-419.10M $30.00 U't:UB-TMAL CONSTRUCTION AWD PLM CHEM $30.00 U1011 PRIE-PAI -MS $0,00 TMAL I"F.RMfr FRES MT NOW 1 00.00 RECEIPT DATEDATE I BY.. DATE FINALED I INSPECTOR t INSPECTION RECORD OPERATION DATE I 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 POOLS - SPAS 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 .p 7 Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final . p Utility Notice (Gas), ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) ,fit _., ^•.R.r :. HAMMER PUMPING INC. ;: JOB INVGIC�, - P.O. Box 2448 -A CATHEDRAL CITY, CALIFORNIA 92235-2448 t" I7Cnl 4CA 7AA0• (760i321-7448. _ DESCRIPTION OF MATERIAL USED CUSTOMER'S ORDER NO. DATE ORDERED Q -a ORDER TAKEN BY DATE PROMISED D A.M. D P.M. BILL TO .�(/ PHONE ADDRESS MECHANICS CITY - /� .- HELPER^J`' - JOB NAME AND LOCATION . ^ / ^, I✓ �, / 5 ' 1'O� ❑ DAY WORK DESCRIPTION OF WORK ii D CONTRACT D EXTRA Out of Area Fee QUANT. DESCRIPTION OF MATERIAL USED PRICE AMOUNT - Gallons CC-�O Pumping Fee per 1000 gal. Q >mping Fee per 1000 gal. Out of Area Fee Locating / Opening Fee (per hour) Size System: A SERVICE CHARGE OF $20 WILL BE DUE ON ALL RETURNED CHECKS. 18% PER YEAR WILL BE CHARGED ON PAST DUE ACCOUNTS OVER 30 DAYS. HOURS - LABOR AMOUNT TOTAL MATERIALS MECHANICS @ HELPERS @ TOTAL ' LABOR I hereby acknowledge the satisfactory TOTAL LABOR comptetion.of the above described work: TAX SIGNATURE -. DATE COMPLETED TOTAL _ P.O. BOX 1504 APPLICATION ONLY Building sem'^ UINT CALLE CALIFORNIAESTAD9 Address J __J• `' �'r���A QUINTA, ORNIA 92253 U O Q/VYL �" �r�c- BUILDING: TYPE CONST. OCC. GRP. Mailing 7 Address&x, ��O �/ A.P. Number Cit. Zi Legal Description _ ^- Contractor �( Project Description /�J/f �.� AZ ,�zL ig:�Cr�(�.�,",7 ress City IZip State Lic. City & Classif. I Lic. # Arch., Engr., Designer Address Tel, City Q IZip (State Lic. # (7 LICENSED CONTRACTOR'S DECLARATION I hereby TITh 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 oI 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). l I, as owner of the property, or my employees with wages as their sole compensation, will /ffo 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.) I 1 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.) 1-1 1 am exempt under Sec. B. & P.C. for this reason ;1 r Date 71 ^ �Owner ' d 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 177 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM . WORKERS' COMPENSATION INSURANCE (This section need not be completed i1 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 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. 1 certify that I have read this application and state that the above information is correct. 1 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 DIVISION Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS T ��OtkA1�1A d�TrfTAI ,T ^�4AA^ .R^10 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 FIGS 1ST FL. SO. FT. @ $ 2ND FL, SO. FT, @ POR. SO. FT. @ GAR. SQ. FT. @ CAR P. S0. FT. @ WALL SO. FT. @ SO. FT. @ ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLETROOF YARD SPKLR SYSTEM BA S NK DRAIt�S'•a� ^� r DRAINAGE PIPING DRINKING FOUNTAIN URINAL WATER PIPING NOTE: Not to be used as prcperty tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRY TRAY AIR HANDLING UNIT CFM HEATING (FINAL) KITCHEN SINK ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET COMPRESSOR HP POLE, TEMIPERM LAVATORY HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER B.T.U. SO. FT. @ c BATH TUB BOND BEAM SQ. FT. .@ c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID @ 1 V. c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR @ 3/4c HOUSE SEWER FRAMING FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE I 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 APP./EQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus xS =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING 4" ' ' REMARKS: VENTILATION _ FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATION/SOUND FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S 51GNATURE3/INITIAL5 GARDEN WALL FINAL