Loading...
0103-105 (PLBG)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 Date 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). (ol, as owner of the property, am exclusively contracting with licensed cintractors to construct the project (Sec. 7044, Business & Professionals Code): () I yam a empt under Section , B&R:C� ;for this reason. Date � ti 1 _ Signature of Owner >)t% . v% 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 Policy No. (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 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: 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 representatives of this City to enter upon the /above-mentioned propertyffor inspection purposes. 1r': � �� �':.•..r '• ri Signature (Owner/Agent).`'1. `�++ ;��y � � ' Dates ) "t BUILDING PERMIT PERMIT # - ,".- DATE VALUATION LOT CIM -105 TRACT JOB SITE APN ADDRESS AAA ��[)O g y �.//rr���� f. �{� Q �] A7�, p� p a X44 o& v�si9.TLIX SAA �.CJ:.IGIll�Jt.l.�.fi�?RA. -• •- OWNER CONTRACTOR / DESIGNER / EN (NEER :-T`9`WARDYMRXJi0 .¢4,-580 CALITY, SANTA OWNER—BUILDER L& Cj1ftTrA CA. 92233 USE OFyyPERMIT 3yyqpp yyin 30 F1311. AF.AS 11NIZ VALUATION I AD -00 1:8 991MIld,'M cc M11 OF R„o3AiFlavelloff F113hirt15140F1.01. 10 t_000-13.9-wo $!gM t a MAR 14 2001 31T Y_ Vr LA 8UB-'MEAL. C;0:A0rTRUTa"7:' ONNID. PL4%N A•L_111C :LEM, FRR-PAM FEES RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE TINSPECTOR 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 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 Gas Piping f1D Gas Test Encapsulation 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: OWNER/ -BUILDER INFORMATION, Dear Property Owner: An application for a.building permit has, been submitted in your.name'listing.,yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/,Builder''. you are the`responsible�.partyof record on such a permit. Building permits are not required to be signed. by property owne'r,ilnless they are personally performing their own work. If your work is being performed by someone' other than .yourself, -you-may protect yourself from possible liability if that person applies for. the proper permit, in, his orflier name. Contractors are required by law to, be. licensed and bonded ;by.the State of California and to have a business license from.the City or County. They are;also required by law=t6ip,ut their license 'number'on" alFpermits for which they apply. If you plan to do youvown work,.with the exception,of various trades that you plan to subcontract, you should be aware of the following information,for your benefit and protection: If you employ or otherwise engage',any.peisons other than-yourimmediate. family; and the work (including materials and,' other costs) is $200.00 tor- more for the 'entire project,.. and such persons are not licensed as contractors or subcontractors, then you maybe an employer. If you are an employer, you must register with the State and Federal Goverriment.as,an employer and you are subject to several obligations including, State and Federal income tax- withholdi,ng,`federal social security taxes, worker's compensation insurance, disability insurance costs'and. unemployment competisation contributions. There may be financial risks for you. if you do not carryout these obligations, and these risks.are especially serious with respect to worker's compensation insurance. For more specific information about. your obligations under Federal, Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small,Business-Adminstraiion). For more specific;`;'inform'att'' about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. . If the structure is intended -for. sale; property owners ;who are poi licen'sedi contractors are allowed to perform their work personally or through;their4owri employees, without `a licensed contractoi'or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing„to.-be,contractors�is' to=secure an,!'Owner/Builder” building permit,. erroneously implying that the property owner.rs propicl his 6r. -he •own labbr� and material personally. Building permits are nor required to be signed by poperty,'owners- unless ;'they 'are' performing 'their own work personally. Information about licensed contractors may be obtaine&&y' gontacting the Contractors' State License Board in your community or. at 1020 N. Street, Sacramento, California 95814. Please complete.and return the enclosed'owner-builder verification form so.that we,can confirm that you are aware of these matters. The building, permit will not be issued;iintil the:verification is returned. Very truly yours, CITY OF LA QUINTA` DEPT. OF BUILDING -AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 (760)'777-,7012 760) 777:7 O WNER' S -:SIGNATURE? DATE - 5 c7 Cry l : Z>` PROPERTY ADDRESS"". PERMIT NUMBER(s)