Loading...
0009-016 (PLBG)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that 1 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 r,. i Exp. D ter 1 a cc'f %� 1/2( 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). ( ) 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&RC. 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 R1a;1MPT Policy No (This section need not be completed if the permit valuation is for $100.00 or less). (y!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 Cal iforni � and a' ee t tt ' should become subject to he . orkers' compensation pro �p ` off cti6 37,0©'of the Labor Code, I/ fl `rthv�jth comply with th �se o Ions!/ Date: �'[% Applicant • G - Warning: Failure to secure Workers' Compensation cover is unlawful and shall'subject an employer to criminal penalties and civil fin sup 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 &nd state that theabove information is correct. I agree to comply with all' 'City; and St to la .<rVe thing to the building construction, and hereby aut drize.:rept�esen tives of Is City to enter p n the above-mentioned prop�rty ff�r' ns�cti pur o Signature (Owner/Agent) Date � V / 2/) BUILDING PERMIT PERMIT# DATE LOTyG TRACT !VpLUATION�. APN ADDRESS 79-,(l/�` COW= LA 0 OWNER CONTRACTOR / DESIGNER / EN (NEER 79.640 C ORTN6 LANE 7"7 MBO e L,AQUITNTA CA 92233 V"LC?T0l [G t Cl CA 92392 (760)244-6341 M110 38261 USE OF PERMIT :L'I.;LMM40 (1) WATER H ATKR, REPLACEMENT ONLY r VALVA'1101,11 311+7.00 &'1 E S IM AM COST OF f,'L01V ';A 11i~IJUFt0Yq 300Z9 IP.T YJU IsVALM"Y PL UMPIM0 YKE 101.000 -419 -MID $2.2:50 h RUk3-'40TAL cow1uTkiT'ICITION ANO PLAN CEE, CK a 1Y.90 PRE -PAW 1EES $0,00 TOTAL FERM'FFESDIFE NOW RECEIPT DATE BY,_�M I DATE FINALED INSPECTOR INSPECTIOO ' EC�i�F'?© 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 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 FOOLS a 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 Encapsulation Gas Piping Gas Test Applianc / tcpy Final Final O� Utility Notice (Gas) ELECTRICALS 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: