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Home My WebLink About9607-102 (PLBG)N W O d co W� Z r 0 ��z0) W W f— tn Z 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 537333 A L W3119E `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&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 $actio n 3700 of the Labor Code, for the performance of the work for which this permit is .issued., My workers' compensation insurance carrierh& policy no. are: Carrier "'1'n"f'f,}cI� Policy No. J 1its�t31-9ti (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�o the workers' compensation provisions of Section 3700 of the Labor C Jo 4'l 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 ,sorrect. 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 a OVe-mentioned property for inspection purposes. S gnature (Owner/Agent) Date BUILDING PERMIT PERMIT# °°NTR°`# 'tfif97-14Ex 37 `� I� DATE 7126/9, VALUATION $1-000.00 LOT TRACT' / G JOB SITE 52-105 AVL"NtDA C;ORTEZ, APN 773401-018 ADDRESS OWNER CONTRACTOR/DESIGNER/ENGINEER ff1o1AN R'QUNC.AN . munm fsI1., Trig.. 32i(KAVENLi7:i.t�®it1Z` 51-001.E1SlaNKOWEl DR. LA QUIN'd'A C4. 92253 LA QUIN-3'A CA 9.225: (ISKj56443_19 CB)".4 2526 USE OF PERMIT f 1aui�lLS.IAic,; .NBANDON SI+P fC 4.YSIE' 4 . i".tt�i�dGif<C'I' j•tt�!'1'�i? 1"t"l, `;( Wi?� VALUfi'PIGN f,illtOM .LS P1.11A,I fT40IET1 St'i,WF R 101-000-41941110 $3ia�ffD `U13r•cM1� f:`t3N�.TMK`I` ON AND taUUN CHECK. Si(t.DU i,,1JSS PX13-:11AID R`EF'S aG.t1(t JUL 2 6 1996 RECEIPT DATE FINALED INSPECTOR 530,00 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 Wail 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 Pibg. 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 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: - W V Z 4a4i 2502 Morongo Trail Palm Springs, CA 92264 No 18742 (619)327-8859 SOLD TO SHIPPED TO TERMS ..0.DATE STREET NO. STATE STREET NO. a 7&', -TY STATE // ZIP CITY STATE ZIP Da /3's, o CUSTOMER ORDER S L SMAN TERMS ..0.DATE Da /3's, o Vf X 1! b , PAYMENT DUE UPON RECEIPT -- -- N! ONO i Received From: 'LY Address: S Account No. - ot(s) Service Address- ❑ Meter(s) ❑ Service(s) ❑ Backflow(s) ❑ House lateral(s) Tract G.A. Code