Loading...
0007-243 (RPL)D LICENSED CONTRACTOR DECLARATION I hereby, jffirm ,ur,Jgr 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_--­----),E�x_p._Date 13TSGA.t f �i13•t362c k./at,�'�, Tmd .) Yf Signature of Contract �� � ,f_ � OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 1, 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 1)49, COMPANYflR 7- Policy No. WDF,170041900 (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 a ner so as`to become subject to the workers' compensation laws off California�a d agree that if I-Ishould become subject,to the workers' compensation.provislo s of Section 3700 of the Labor ode' Pshall•forthwitj� comply with those provisions. Date4' r��� Z 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 applicatiomand state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby.46thorize representatives of this,City to enter upon �/Ulebove-rnemioned,p opertyfforri peection,purposes. ature (Owne gent) /- �f610 BUILDING PERMIT PERMIT# D TE VALUATION LOT -243 TRACT JOB SITE ADDRESS CW SS ,�OINT APN _ OWNER CONTRACTOR / DESIGNER / EN (NEER "xi T 7�iV MEM. , WC. R:f f 12tTVEtiTMWI , WC , 14251 iy7 IVERR��'J.°Y` DRIVE, 1425 R 17MVERSYTY DRIVE 7701 e'rK A: 85034 B�1` OE1�7IX A7 V5034 (692)257-1656 CMM X4990 USE OF PERMIT P001, MINOR SPA S15R1U M Si'WA. HE IN PLACLE.AT yPO�y, t�OLry11&S�cgP�AL.�g0N1,,!Y�AI_A7sInt.Dx PRE-P7.AS I FR ti'Pe7�^ C L JOW VALUATION 10.1000.00 US J�3"�'1'.�0 COST OF C.ONS�'1�VC"2'`kt�U 2ti4000.00 1�EkL1V1'14 '� 81;. MMA Y K 14 CHECK 1�'EF 103-0100-4-39-318 157 .0.5 C014S'I'1 UC ION PIM, 101-€7001-4.18-000 $11°1.08 MECH A,14ICAL. k1l ,. POOL 101.000.421.000 `�,1 ` $24.00 EL.EC IVICAL I + ,-, POOL 101-000-4.20-000 ..-.�.1'Z,UM13.1140 1'C� ii, ., 101-©00 190(10 WAD T, xr WAL C':C))�s``�-ROCTION AND P1 • Crl� CK LM PRU-PA10 IMS $0,00 MAY, MIM r 17M VVE, NEW �r0� RECEIPT DATE BYn DATE FINALED INSPECTOR t _ b 4 �. OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts b Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans 0. 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 I BLOCKWALL APPROVALS POOLS - SPAS steel _ li Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I 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 6 d - 0j ANT Gas Piping Gas Test Appliances r 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: C ,D S. -e �ry CITY OF LA QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION DATE U 16 IdO BY____ ;;�, A RE -INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED PLANS AND 10B CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. NO EXCEPTIONS! No c s vl