Loading...
0203-415 (RPL)U) I— N to W O Q � f; W OZI� 0. H t0 J LLL LU F- a U) Z ch LO N ON U °) �a Nt Z �-0 LL 0 J J IM U U rnH 't Z ao �" 1_ J 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 656121 053 FU $ 1 31o2t Date M� 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 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. ( ) 1 have and will maintain workers' compensation insurance, as required by S2ction 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: Policy No. Carrier `!'iir C3MP . AT.1 t34�hiif341€Ss� Uf. (This section need not be completed if 1he 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.._ Date: ' • 1 9 L : Z. Applicant r(•„ I!�tr c., .•F z .....:•• '1 Warning: Failure to secure Workers' Compensation coverage is unlawfd shall subject an employer to criminal penalties and civil fines up to $l od' in addition to the cost of compensation, damages as provided for in Sectio 3 06 of the Labor Code, interest and attorney's fees. A[ IMPORTANT Application is hereby made to the Director of Building an Sa for a permit subject to the conditions and restrictions set forth on hisCU application. f 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 forlinsplection purposes. Signature (Owner/Agent) ArJ--Date:)- PERMIT # .� BUILDING PERMIT DATE VALUATION LOT C-70'5.41.5 TRACT $24AX tM) 30 JOB SITE ADDRESS • r n wTM.ria f?) 0.I •� vs Y-,6 I APN OWNER CONTRACTOR/DESIGNER/EN INEER I1,Tao V KmL nnow C oNackllJtSl4ss, Dic ci .:E CR): 6t,1%•€',4C 1,S fi i31yA.I ,(:: t3P MAN C0 200 F' WAaHMUM1;T.AVX 0100 74725 JQNTE)MVE, 51TiZ'. OA, ESC;ONDMO GA. 92= �,°.e�//.^���9qq:�ty'�,(60 2?A s,A.pi�a� �7F.y�4(.r ^, � ( 60)3 4a4'9000 '4..f.Y. 4l, Ol/�u , m(60)3O-9000 USE OF PERMIT :R=C1©Z. AND/OR OT -4A Pf)C3I, AND SPA.. 588 AV31.211-M-1995. WATER MA'PURK AL-4it.i►{WDAR.R1P'1S 0, RALL L BYE IN PLAC& PRIOR TO PRE-J"LAB x ER I -NS EC:'4ION. 11O01,'?QUf M1ZNT MCILt)S1 P.R..140`f ><NCLUDBD rN PZrCMIT. POOL AND/OR SPA 74,001100 L3 .,. E hTWATM) CC/61': 01x' C{',;?1+T8Tru:U 10li P'63&W EWE SUMMARY PLAN CHECK EE 1,01.00", 39-318 $152,10 MEO3if►NICA%,k'%-•POOL 101-000.421.000 $24.00 F ,CTTUCAL nT.33.,?,PPOL 101-000,4.20-000 $4 5. (W PlIUM133.NO IT.N . POOL 101 -MO-41 ` -000 527.00 _ y 'R 0 12002 OFLAQUQRTA 10M CQxti1'TKRUCa17ON AWD PT"' CHECK•i 0 RECEIPT DATE BY DATE ED, NSPECTOR P. 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 POOLS - SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond 7 Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test—CTS Final Gas Piping PLUMBING APPROVALS Gas Test _ 1 _14PI 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 or Final COMMENTS: 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)