Loading...
0307-037 (RPL)LICENSED CONTRACTOR DECLARATION _ PERMIT# U) I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT 4'�1J ii' I•- Chapter 9 commencing with Section 7000) of Division 3 of the Business and DATE VALUATION !i �243yCfi1la�if� LOT , TRACT Cv W Pro esslona s Code, and my License is in full force and effect. [1� M� p =) ch License # Lic. Class Exp. Date d Q v��}VSi7 :"J.� ` 1�% iJ � ADDRESS I ti^&10 �:ii.ED:� K APN t-- 0 Z a/Date f'�� Signature Of Contractor OWNER CONTRACTOR / DESIGNER / EN (NEER C) OWNER -BUILDER DECLARATION -18 .� J .64 0 CMMLO WAY X91880 N -10i 3� 1NNI E_ r ,1�, DIZt,TE fA` W W r- I hereby -affirm under penalty of perjury that I am exempt from the Contractor's Y q- r T r•� b I- a .LJ'. k7149TA C.A. X2253 l�T.i,:.,t' N �irIfIf 12 .i� 9221 Q, U) License Law for the following reason: w 60)",14$ "?(' Z_ ( ) I, as owner of the property, or my employees with wages as their sole (' t'"3 .r♦` compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed P00L.AANNOR SPAS, contractors to construct the project (Sec. 7044, Business & Professionals Code). 3F.r E, 5 .A7, tad�4 �i.•:i�si •ayr3,, : T,.. 751.7-51-t. rir`.ru.c� 7trt.l- c� () I am exempt under Section , B&P.C. for this reason '1"iiTdb3Alke�,l".LCef� IJJ?7 Ai$1�17a•b�^: ti'•331+4.!, E3j t�+ �'E.a�CZ AT i R&PLAINTPLO • . N Date Signature of Owner D.i4_1';?ZC;:ION.!r;A O N 0) Q WORKER'S COMPENSATION DECLARATION " orQ Z I hereby affirm under penalty of perjury one of the following declarations: 4 FT, 'MALL FZ O () 1 have and will maintain a certificate of consent to self -insure for workers' POO Sllp..-, �9,J�irs.flfl' ii X W compensation, as provided for by Section 3700 of the Labor Code, for the C0 0 � Q performance of the work for which this permit is issued. Q U ( ) I have and will maintain workers' compensation insurance, as required by O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this a rn H permit is issued. My workers' compensation insurance carrier & policy no. are: .�t Z Carrier EXEMPT •1, EEE SUB1. Policy No. ]'S%TilyAlI 'D C0 �C (:W CONSI:RCM1111,10. t w O 'jk d id , 'h a C14 f%ti<i�3t Q (This section need not be completed if the permit valuation is for $100.00 or less). YSrn �N CHECK FEE 01-00.10.439.318 V'V J (I r I certify that in the performance of the work for which this permit is issued, a..t?•NS'fRUC TION K72, i? -WO g 3z.tm 1 shall not employ any person in any manner so as to become subject to the wik;f:HANIt'AJ, FRY. •• KXX.., I01 -00042'J-1000 workers' compensation laws of California, and agree that if I should become 'Q,*W.T ,I- L. FRE POOL 101 -;:0t -A 2r-000 subject to the workers' compensation provisions of Section 3700 of the Labor t;I 41M;314CI!<:-- 1°01+ 101-:tM,lr-C► 8u4 Code, I shall forthwith comply with those provisions. Date: % 4 .Applicant ') ?.t 1 .. 1 � i� �f•- 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 SM -TOW -1 Zk�.C1 "I"1. X23 thA'� )l %41M,ARPIR 114 . 1.801 whose request and for whose benefit work is performed under or pursuant to AJAWS ,(;; .PAD FIRal$0,00any permit issued as a result of this applicaton agrees to, & shall, indemnify D Lr_3 L1 r� V & hold harmless the City of La Quinta, its officers, agents and employees. ,��,.�. �4a`S�i9ro• 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 JUL 0 8 2003 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 C!'°" i` +. ' correct. I agree to comply with all City, and State laws relating to the building F1p+�+•lti` G frf'T. construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. RECEIPT DATE / BY ,� DATE FINALED INSPECT Signature (Owner/Agent) Date Y�' INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Se 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 BLOCKWALL APPROVALS Steel POOLS -SPAS _ 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 Neater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX 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: CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DA 3 By� ESIDENCE P/L EQ i HOMEOWNER PLAN APPROVAL SIGN: DATE: NOTE: HOMEOWNER RESPONSIBLE TO WATERCURE GUNITE TWICE DAILY FOR A MINIMUM OF SEVEN DAYS. HOMEOWNER APPROVAL DATE REVISIONS: BY: BOULDER SPILLWAY BOULDER WATERFALL /L +6" RBB +3691 uL N SPA +18" POOL SIZE: 2 7' X 14' POOL AREA: 292SF +6" RB QUARTZITE COPING SPA SIZE& 61 k 30 SF PA R: 21 FT DECK AREA: 590 SF PATIO AREA: MISC: 2 HP PUMP 400K BTU HEATER 400 SF CARTRIDGE FILTER +6 RBB A UARITE SALT CHLOR � ; �►�� tea. . :p= BILL & MARY DEAKYNE ADDRESS: 78-640 CABRILLO WAY 2 STEPS 6" RISE EACH DATE: 6'-0. DRAWN QUARTZITE WATERLINE m -3'-e" R PLANTER +12" 16'-0" R QUARTZITE CAP 21-61f R e m SKIMMER P/L AUTO FILL 4 d 5'-0" R o o BBQ v - v v EQUIPENT WALL 4' HI QUARTZITE COUNTER TOP 5' LONG STUCCO AND PAINT SIDES EXISTING PATIO DECK CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DA 3 By� ESIDENCE P/L EQ i HOMEOWNER PLAN APPROVAL SIGN: DATE: NOTE: HOMEOWNER RESPONSIBLE TO WATERCURE GUNITE TWICE DAILY FOR A MINIMUM OF SEVEN DAYS. HOMEOWNER APPROVAL DATE REVISIONS: BY: POOL & SPA SPECS POOL SIZE: 2 7' X 14' POOL AREA: 292SF POOL PER: 73 SF POOL DEPTH: SPA SIZE& 61 k 30 SF PA R: 21 FT DECK AREA: 590 SF PATIO AREA: MISC: 2 HP PUMP 400K BTU HEATER 400 SF CARTRIDGE FILTER A UASWITCH CONTROL A UARITE SALT CHLOR � ; �►�� tea. . :p= BILL & MARY DEAKYNE ADDRESS: 78-640 CABRILLO WAY CITTY: LA OUINTA DATE: SCALE: 1 "=8' DRAWN JOB 4 ■ .-.•r..�..... �•/)`fir �rx rc '10 k rcnrvii r IMUIVI CK UWNEK BUILDERS jn&M5RAV3, i M)S FCV1V JKk-, This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response. Trade ! Classification Contractor State Contractor's License Workers Compensation Insurance City Business License Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) G CA" D 0�.SS0 11J!!b4 S T �C.1.�/ i� an ^ Lo'(r] � CONCRETE (C-8) 41 301 t� �, s3 2C�� � 3'7 (/ t7! n .r FRAMING (C-5) 1' 40`7 'Vg 7 0•6 '194 .5�1/0t J STRUCT. STEEL (C-51) S%A v-I� 00,2 yq ge? 61 10.4 111:31 MASONRY (C-29) PLUMBING (C-36) b�'141 `�: /'� (f0li�b 16 31lo4 JiXYT li%7 9'44— o`/0 0 06�� LATH, PLASTER (C-35) DRYWALL (C-9) HVAC (C-20):. r ELECTRICAL (C-10) a y; �� �� p �735��0 1111/64 CO'ZL 0110 �i ROOFING (C-39) SHEET METAL (C-43) FLOORING (C=15) GLAZING (C-17) INSULATION (C-2) SEWAGE DISP. (C-42) . .. PAINTING (C733) , CERAMIC TILE (C-54) CABINETS IC -6) FENCING (C-13) LANDSCAPING (C -27) - . _ 1✓^'] 1 — f�0�'%3� 1)l 4 6-6 7Z� Dj 7 b POOL (C -53)r. L�s3 G� �a b+�O ©� �iE7 (� 1I