Loading...
0004-224 (RPL)U) I— O LL CY iM ' W oZI� Zo0o Z co Ln N O� U CL Q '5- Z tr SHO X W mQU O 0, rn H It Z ob ::) �d J 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 69!0775 C53 w27 B Of D ate Ol. !�. s7 Signature of Contractor 1__ -- Y// 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). ( ) 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 STATE PUBO Policy No. ID614 I-00 (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 3700of the Labor Cocle, I shall4orthwith comply with,,those..provisions. abate: � f/ `"'_ Applicant - 4 _ 1, ..s': jr��,..,-..--..».,-^~•_.. Warning: Failure to secure Workers -Compensation o era-I� 9genlawful and shall subject an employer to criminal penaltie` 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 prop erty-for°inspection purposes. IS gnature (Owner/Agent)' * i� _ `� �.-"`�� Date BUILDING PERMIT PERMIT#OW4'��� DATE VALUATION LOT TRACT U51000M JOB SITE APN ADDRESS .9-2Q c ,au OWNER CONTRACTOR/DESIGNER/EN (NEER NIUK" AM I)AU PAIL M :k3:YRTSES 79-240 CITRUS 81965 INIO N'. ADT V110,W LANE LA QLTWTA CA 92253 LA QUD4TA CA 92252, (760)398-1766 CB1.# 1688 USE OF PERMIT POOL ANDIOR VA. POCK. &SPA ONLY A)-4 MW -BRIERS SHALL BE IN PLACE AT PR&PLASTER RWECTION VALUATJON IS,00©.?t0 U ]48'I`t115A.Tfi-.~O COST OF CONS R1lJCT ON 35,000,00 �kr t�t+1Lt'� x+'�i�: 8ifll:ll41�t932� PLAN CHECK 'FER 161.000-439.318 CO NSTkUCiICIN F&C 101-000.418-000 $162.00 MECHANICAL WE -- POOL 101-000421.000 $24,06 ZL13 rP,1CALFR -POOL 201-000-:4.20-000 $4.5.00 PLUMDR46I+E.F - POOL 101.000.419.000 $27.00 SUB -TOTAL CONMUC1103S AND PLAW CTIECK $363.30 LM9S PRE-PAm I -T,4 S $0,00 p RECEIPT DATEINSPECTOR BY DATE FINALED •-r 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 OX 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 POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping IV 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 Gas Piping Gas Test Appliances Final COMMENTS: 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) r 9 'Y�IL POOL SIZE 1iXzQ DEPTH TO_5'—TO,3 TEMP.NO. FILTER NO. SHAPE=NO. RETURN LIffES- ACCESS_Q FT. FENCE 13Iu% MOTOR PUMP A/ HP LIGHT HEA�Q&V ,Q) ELECTRICAL 470 TILE/7A4pF GAS/PFT. TILE��DECKING- � NirU.lANII!`SW - —� .1 IMAR s -... J. L� I.L. 1,, � .' . �• ""_ -� S ��N yr�"I�p sono,_µ �Tueco w+e>o it, . e ' Flo o (� . PERM. POOL- SQ.FT. POOL 3/0 POOUSPA NOTES ri PER SPA Zy SQ,FT. SPA�"�_ -;Z&5e4 5Pi¢- ni J r :�.n.: Ti1A7 ,�Rifiii �,.• 9 'Y�IL POOL SIZE 1iXzQ DEPTH TO_5'—TO,3 TEMP.NO. FILTER NO. SHAPE=NO. RETURN LIffES- ACCESS_Q FT. FENCE 13Iu% MOTOR PUMP A/ HP LIGHT HEA�Q&V ,Q) ELECTRICAL 470 TILE/7A4pF GAS/PFT. TILE��DECKING- � NirU.lANII!`SW - —� .1 IMAR s -... J. L� I.L. 1,, � .' . �• ""_ -� S ��N yr�"I�p sono,_µ �Tueco w+e>o it, . e ' Flo o (� . PERM. POOL- SQ.FT. POOL 3/0 POOUSPA NOTES ri PER SPA Zy SQ,FT. SPA�"�_ -;Z&5e4 5Pi¢- .7�NDV �2C'riloir LANDSCAPE NOTES L&d i!lAin�rr DR IP, ONLIi LOT OWNER. __177IJaZ 444. DATEQ)PALMTERPRISEs 'JOB ADDRESS -2w 1Z;PMENjftNC. — _ -C� _ VClMAL AZAtVSCAPE TRACT CITY S _ 7 a;'k"az:,Q7 Qj 3W2378 RES. #, BUS. # $`C1iEiiltA ," t ki712 1; C"5j; C.2.1 75 r