Loading...
0009-211 (RPL)LIC _v CONTRACTOR DECLARATION I hereby affirm undi 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 EX/Plate ,r' 638335 B ` / e. ODate I X:57'" ` Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's !F 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 tie 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. (f:)` 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 FUND . Policy No. 2290-CODP671 (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 Se tion 3700 of the Labor Code, I•shall forthwith comply with'rthose provissions. 'Date: Applicant c'✓4,' Applicant Warning: Failure to secure Workers' Compensation coverage Is unlawful and i 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 Seotion 3706 of the Labor Code, interest and attorney's fees. / IMPORTANT Application is hereby made to the Director of B ilding and Sefety for a permit subject • to the conditions and restrictiorts set forth on4his 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 pursua tt to any permit issued as a result of this applicaton agrees to, & shall, inde unify & 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 6f.,such permit, or cessation of work for 180 days will subject permit to cang�llation. 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 authorizejrep reseggtatives of this City to enter upon the above-mentioned property -for inspectiotfpurposes-..- Signature (Owner/Agent) X, +� Date BUILDING PERMIT PERMIT# f DATE - VA"TION LOT �`�-� TRACT 'JOB -SITE ADDRESS .5"10AVEMA JTYAI APN OWNER CONTRACTOR / DESIGNER / EN INEER PO '12 BROXERB L TIMI i, VwriJRT l WC. ,4,054-4 10 AVI.fiT DAJUAREZ 70.00 CAI.. E='ADO, UCil'L'R 2034 LAQTJINrA CA 92233 LAQU fA CA 92253 (?f(3j554�Ib6G CBL•I� �35� USE OF PERMIT POOL AND/OR SPA. POOL & SPA r)NL,Y- ALARMS%RkRRIFR,S StiALL ])E NA.A.CF A`f PRE-r-PLASTF13 INOPKTION, BLOCK'IFlr'ii14 KA, POOL EQUIP:MI±.NT ENCLOSURE IS NOT MCL,UE&D IN THIS PEtL` IT POOLANDiOP. SPA 191000,p0 La EST:�1V.IATX13 COST 01.r Cont" 'Ucnoiq � 2.0;- 001 yq �q'��'�� Fry7�;��� �`�p�7�,�',�p'.� Sri[31�.6ar ice.+' l7ilJ�yiiY.�t'l z 9 # PLAN CHECK FP -1s )01-000-439-318 $31,90 CONSTRUCTION FM 101-000-418-000 $176.00 MWHANICAL. FEE -- POOL 101.000-421.000 $24.00 M ' =1UC!l L FEE •- POOL 101.000-420-000 $45,00 LIUMBINO Fr,,E -- POOL 101.000.41.5.000 $27.00 SUB-TOU-AL. CONSTRITC11ON ANIS PLAR CTil-.+'.:K $303.90 L)5213 PRE-PATDP= $0.00 TOTAL 1?'Kl::t' I`.E8 DIXE NOW 9403,0 RECEIPT DATE D INSPECTOR � V_ INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Steel Return Air 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 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 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 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)