Loading...
0011-220 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjthy that. I.Lm 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 275796 C-53 C-18. � 11/2.' Qate SI nature of Contractor. OWNER -BUILDER DECLARATION A• 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). as owner of the property, an? GXGIUSIYBIY COntfdGtiflQ with IIGBns@d 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 thee, 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. ST•AT8 FUND OdQ-ti0-00&t�fi�3 (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�370..0 of the Labor C66,11 shah forthuf/ith,comply with those prow sions�7 -- __ v date: f'l' ./ e`_"'' pplicant a•-r'� '' r,° :. %;•- _.._ . Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer fo 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.] 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 property for.inspection purposes �,S g ature (Owner/Agent) Date BUILDING PERMIT: PERMIT# ; Y TRACT , DATE VALUATION LOT TRACT JOB SITE APN DDRESS 79 CAUX 1"AUM, t OWNER CONTRACTOR/DESIGNER/ENGINEER IfFMON 2000 PALM DWER : CA 92211 GXMhT?•RAL, C::• 7T • : CA 92234 (761CO) 2Sn'?515 C,`Bul. 69 USE OF PERMIT POOL AMOR Pry PLMIANPld ONI.,' ,Ai,A)MMA.I:f:PERS, SHAIA, WE 1114 ;'a-.Flt:I:..tVP ' PRE -PLASTER INSPECT ION. ;'006 EOUIPM1✓'WT ER( WWRE Is NOT l;'ld4vl.><iOl D M THIS PfsR.t1+I.I'1: POOL Ar WOR Sri IZAIDA 1B - - ...r11Y A.��d.S�y-' Q+^v4dAr.X ©�Oi•4Vi1fI,�d!..L4.9�����."e�^SY. 71.E(>!\/YYir76.Y PLM., C IRC K FEE CONS"s'I:asC"1'IO'N FEE 101-•000 18.000 S14d.Q� MECHANICAL FER P01111 101-000•421-000 ,na f 1d C TRICALi lfEE -.o POOL . • . 101-01bi-420400b �+dS.ttU FLUMBIWO Fkg :,. P001..` 101 ^000-419.000 $27.00 1 MA-1WAr�L C c' Ne"Ik'A WE.O'I`iAWD 1.1L N C`TELM FV RECEIPT DATEABY /� /� 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 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 BLOCKWALL APPROVALS steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test FinalGas 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 Encapsulation ��— Gas Test Appliances 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) Final COMMENTS: '�`r.' � � .� • � �U'°... .. L.�., GYM � LOT 19 � 0 0a,t I �, O 1 _n fn .C% n ° PLAN 4R.0 W m n 01 N< PAD=82 5 �~ SDN + � �♦ ry N FF4:=,83- s LQ (7 - �- 82.5 CITY OF LA QUINTA BUILDING & SAFETY DEPT. A RE -INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED APPROVED PIANS AND 10B CARD ARE NOT ON FOR CONSTRUC THE SITE FOR A SCHEDULED INSPECTION. NO EXC. DATE / ��� ' oD Y EP110NS!