Loading...
9905-242 (SFD)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 Dater 104/ d 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: v ( ) 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). O 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. 00 1 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 Policy No. LR6: T At.. INS, Wt Or :t 'PTC 45 237 (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. ¢ate: Applicant °��• ' j/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. ignature (Owner/Agent) Date"' + BUILDING PERMIT PERMIT# f - f DATE(- �f VALUATION S,12-4,33(ljo LOT 3� TRACT n6ol«'I JOB SITE ADDRESS 47 -US SILIVlEiRTHE V ".s+TRE ! OWNER �I�i:y 1 (7 iyy 1 At }�/��d��f ryS 1�7 CAIMI i,; 1-rd.°i3 ,ti v.�illA:.ii�R�t'13. i.�.J.[i'J, yud.4i iit, p.Yl L' c;Yy SCO/NT/R•.ACTO(R/D�EySIICG+NtE)R9�/tE�NGINE2�E1�R# Af / r1t,1{ quit f Y F iVty, i.F.�4� i:•irl..�>:+ t�U.Y iDf.ti-'6 "•�(:'61:. l...l./,I.N w��{. [\i /'•u .071.N i PARK PLAZA, KIME 4W 5 PARK PLAZA, }'ii.TfeE 400 lR'+lLt�' CA 9261 it IRVINE CA. 92614 {9411)1251.6100 Ci3sr#T N72 USE OF PERMIT Sk!""d�l'LP-.%ANit1,"'f' i'1.if1+"E,LLING UR,'P�1. 2'.L.:�N G�"�G'}% iac.)w'[',i()ty C� �'P�.kt7s"I)tl'C;f� •7��✓u FCjR itrLiJt.1 }�+} TRACT CONSTRUCT VION 2097.00 SF PORCt}7PA'! IO 124.00 S:P G.0AQEJC.,tI}010X1 SF r EXT INIM , D CMIT OF CONSTIZUCT Ria, d 124,3330 D?RANIf. FEE SETWIMAD2f 001SIST'Rtifr FIONFER 101-000-418-000 $7 1:t3:► T,N r;N?�.; T4s 01.1••41941 S; ;������:�a�.€r,�,.r�s�. ,•�.°cath-��-� ��.�e IRA-; rfWAL. F 101-000420-M �c��..,}>��.♦y,p Tf[, "n?'(7WO !,A1„•t ifYN ��.':) — e4k'ri�f,f,�! GRADING FE, 6 101 -OW -413-000 X20: 1191.11i.t1ll TRU'CTIUM. rw 223-{}00443-342 $2.740.45 ART IN }AM;aG PL ikCES - RES1.0 704 000-255. 51 16034 � r h S -` CYt'AL COMMA”,710N AND PJ A J CHEC-K, ", ,090,42 L, S D",i T l'��ll ) a X0.00 1999,170TAL PERMIT FEESDUE OW $4,090.4. RECEIPTDATE j:'= ••: t. BY wj DATE FINALED INSPECTOR t :r INSPECTION RECORD OPERATION =DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings _�. , / c Underground Ducts Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap 4.F.A.U. FramingB - — — 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 08 Final Final k BLOCKWALL APPROVALS Steel POOLS -SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Water Piping Heater Final Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection - T - Encapsulation Gas Piping Gas Test —/S— 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: