Loading...
0004-058 (RER)LICENSED CONTRACTOR DECLARATION t 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 t1�Ai , / � / ©% /t Date Signature of Cohtracto{ 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. ( ) 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: Carrier $TATs? FUND Policy No. 046-0007333 (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 mann r s� o asst become subject to the workers' compensation laws of California, and agree t1at if I should become subject to tKe workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. • I,:� Date: /irfL� 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 representatiiv9s-o, this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) - Date fl]�W BUILDING PERMIT PERMIT# DATE VALUATION� LOT -0'� S TRACTJOB SITE 1 APN ADDRESS 79400 CAMP IMSA ` OWNER CONTRACTOR / DESIGNER / ENGINEER M DF BERT DEVMO&'MFAT SPAM CCNF."T12tJ'CTYON PO BOX 1'71.6 79-2951CANCHO ? A Q•UINTADR LA QUANTA CA 92253 LA QUTAITA CA 92253 (760)771-1941 MR 2996 USE OF PERMIT RI! S1DF..N7.'W REMODEL REMODEL VAPJOUS ROOMS OF EXISITfNO RESIDENCE AS PER APPROVED : PLAAS ONLY i . i VALUATION 3,009.00 i,S ESTIMAM. COW OF COiVS1':. UCUON 21010.00 Pte' FF,E 8VWS,TiQ RY PLAN CHECK FEE 101.000-439.318 X29.23 CONSTRUCTION PEI✓ 101-000-415-000 MEC:HAA.NICA14I,C 101.000.421.000 $15.00 IZZLEC'.TRIC AL FEE 101-000-420-000 $15.00 PLUMBINO MR 101-000.419.000 513.00 SIM *10TAL COlMIRUT1109 AND PLAN Cf3ECK $119.25 TX- 39 PRE-1PATD k $0.00 01'A��' R�t�r! %SLS l7TrE _►vta $119.25 RECEIPT I DATE INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Underground Ducts 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. Party Wall Insulation Fans 8 Controls Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 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 Utility Notice (Perm) COMMENTS: JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 REGISTERED INSPECTOR'S WEEKLY REPORT TYPE OF O REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ INSPECTION O POST TENSIONED CONCRETE O ASPHALT ❑ OTHER PERFORMED O REINFORCED MASONRY O FIRE PROOFING JOB LOCA I _ 0� ('-'-A Ile - n �lS h / A Qu `v,,,�./� REPORTq-l(SEOUENCE NO. TYP OF S ULTURE �O� PEE_RMIT NO. (� DA EJ 1 q DAY OF WEEK MATERIAL SCRIPTION ARCHITECT I RHRS. CHARGED F-:- `7(� ' ENGINEER ASSISTANTS HRS. CHARGED DATE CTION CONTL 8 RAGENECTOR � pA e l\i 1.�3iIlS� CONTRACTOR P 3ge I TE, X T& Tom- ' S . 0 wt T I12.� ^le COPY SENT TO CLIENT CONTINUED ON NEXT PAGE O PAGE OF G CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. SIAATURE OF REGISTERED PECTOR '') _ T9 �� / Z ATE OF REPORT REGISTER NUMBER