Loading...
9901-071 (PLBG)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 7461.39 C42 �1��itiu ate ? • f °" ��Signature of Contractor i 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 SeEfPon 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. ^I'17DA'1V );y�� 4421,0d.4..1i.13V rJ. I: vM �.�� i3V11V`NJ (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 3700 of the Labor Code, I shall forthwith comply with those provisions. Yate: + +'% Applicant `"" / r ,�f 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 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 property for inspection purposes. S} nature (Owner/Agent) 4 - _ Date, BUILDING PERMIT PERMIT# 9')11A48'7Y DATE VALUATION �,� i LOT TRACT JOB ;t p ADDRESS ?aTr-Fi10 A fLN.4,.�.f�l. V iiLL'�aaCO APN P74-1465- V�jal OWNER CONTRACTOR /DESIGNER // ENGINEER LUIS / LUIS S�1L•33'VL AY. EC'O�N0 S���rPR SEIT/ CF 5_i90 AV ENWA VRLASCO 84G5 CASAWN' R -D.7.1.? DIO, CA, 92201 LA QUINTA CA 9225:1 PALM LVISM' CA. 9226", :1 (76( )346-2793 CIAL4 342 USE OF PERMIT PLUMBiN SEPTIC AL8AI•I1.3ON, SCWFA CdNNEC ► ` A3-A40D PROJECT 08-20) COi�fi'iTa,ACf Ali bIQTN7 1,%0.00 LS i / nir 9i. �ftk :e �n�++�..V+JIi w l;h.rlitl�Y 6, M.0�� .vtti t .4 Von no PLUMBING FEE -- 3h1W5R 191-000-4194M S30.t)la S! [Fi-"t� 'A:1, t:C3�a.c"II�L3C."1't9_N . ND PLAN CHPCX ��tl (3t) LESS PRE TAID FEES `0.00 TOT AL PIWRKIT FEj�+" + `DUE NOW S.W.00 RECEIPT DATE BY 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 O.K. 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 PI . 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. ------- Smak4 Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: ppp- ECONO SEWER SERVICES P.O: BOX 192 PALM DESERT, CA 92261 /7Gnl OAG_970*2 /7LM 094.77GA j(Do WORK ORDER FAX (760) 347-4978v - - DAT ORDER— CUSTOMER'S ORDER NO. PHONE MECH Z; HELPER STARTING DATE BILL TOORDER TAKEN BY ADDRESS ❑ DAY WORK (, v ❑ CONTRACT CITY ` h e WTotai amount due ❑ TWal billing to ❑ EXTRA JOB NAME AND LOCATION JOB PHONE DESCRIPTION OF WORK PAYMENT TERMS NET 10 DAYS FROM DATE OF SERVICE 11/2 PER MONTH CHARGE AGER 30 DAYS. Signature above work: or be mailed after completion I hereby acknowledge the satisfactory completion of work of the above described work. TOTAL MATERIALS TOTALLABOR PLEASE PAY F OM THIS VOICE. LL BE MAILED. TAX DAT�QMPLETED 9�1TOTAL WO DEFIED BY AMOUNT $ h e WTotai amount due ❑ TWal billing to Signature above work: or be mailed after completion I hereby acknowledge the satisfactory completion of work of the above described work.