Loading...
0006-158 (RPL)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 -'n iuPl'6rce and effect. :License # Lic. Class Exp. Date Date Signature'of Contractor u. 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) O 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.STAT'E. F'.UNiJ :Policy No. , 1©303-uo (This section need not be completed if the permit valuation is for$100.00 or less). O 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 su4ect to the workers'.compensationiprovisions of Section 3700 of the Labor Bode, I shall forthwith comply w;itWth.ose,provlslo,7s. f Date: '712 r /4 s Applicant'/ � 2. W—W( J 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 representatives of this City to enter upon a the above-mentioned property`for inspection purposes. Signature (Owner/Agent/ �ru { lrra` t`� Date BUILDING PERMIT PERMIT# DATE VALUATION LOTTRACT JOB SITE . APN ' ADDRESS 79-74� 1!ZC1C:..Kt),Ft�1ii ' i"O OWNER CONTRACTOR/DESIGNER/ENGINEER DAVE uppEwr. AVi&TtICM1` POOL COINT cLT(, ON 78.745 Iit)a-.Bk,•RR'-;t C'.tsURT 74960111011WAY 111 ' LA QUINTA CA 922$3 PAS. Dr, SE,RT CA 92235-1 c •. (760)54U�%S Q31,0, 1104 ."(76-0).3 USE OF PERMIT } OOJ AITD/Olt 2XPA. POOL rob SPA ONLY- AI.ARMS1BARi2.11;'fYS SWUA, BE IN PLACE AT PREePL STER R43PECTION, BX:CJCK.WALL FOR POOL EQ1}f'1'►_�ONT Iii NOT INCLUE)FAi B4 THIS PERMIT. VALU.A7101d 18,000,00 1.3 E..3T,0 .t37:E.'D COST 03k ICONSMUC-170M PEMM EE € UMMARY PL"] CHECK YEE 101-000-439-3W $122.83 C034STRUC'ITION Ff✓E 101-000-416-400 IC{9.Oe1 MEC;f1ANlClsi, P'EE -- POOL 101-000-421-000 $61,00 1% ECTRICAL FRE .. POOL. 10.17-000-420-000 PLUMBEN 0FEE - P. -00L 101.000.419.000mID abi JUL 2 5 JfA% 70TAL CfSNSRT1'G`'1:'ION Attl'D PLM.: -p n= $407,05 OV. Lk I foTAL PERIM(TT"W DUE, NOW $40,7,85 RECEIPT DATE BY r DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Firti-)lace P.L. Grills Fire lace T.O. Fans 8 Controls Parc Wall Insulation Condensate Lines Pavy Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Set Backs steel Electric Bond Main Drain 1� Footings Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Gas Piping Gas Test r3 I Final PLUMBING APPROVALS Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation O 08 Gas Piping Gas Test Appliances Final COMMENTS: ($I 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)