Loading...
9907-468 (SFD)LICENSED CONTRACTOR DECLARATION I he affirm under penalty of perjury that I am licensed under provisions of `tihapter 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 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 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 ' �Jtd'[`.i..ED,?AC1F1C.IN'S., . Policy No: ` y yrc (D:171M,► 11 (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 Californiii ands agree that if I should become subject to/the workers' compensation protvlslonsOf Section 3700 of the Labor Code, I'g %,foft with comply with.ose pro islons. ©ate. ( Applicant- -` Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up fines Lip 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 perm it,'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 irispe�ction purposes. ' r `��� Signature (Owner/Agent). /�f: ! Datel �MIT#y� BUILDING PERMIT- DATE fr ' �i�� VALUATION,R• LOT, TRACT 2f3F�J L�1 JOB SITE 57-461 3.FANISK M-LL4 1,l N I,APN 761-09WWO . ... ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER, STE VRI�f a,'AL t HOMES, SIE WAS KER-HC1ME6 7161INDIANA AVE. 716.1 INDIANA Ate?. . RIVERSIDE -CA 92.504 I WERSIDE CA 926504 (909)7944)840 C HL# 5357 USE OF PERMIT ,S.INGLEf."Alkil LY C9IVE1.,.l. ING - - ROC ,._ , C7OL-11. ,Yi -K. W, I. V_ It j - LOT T Ft;di W, RftLtdT DOE 1. POOL. 73% REDUC HON TO PLAN CHECK iFOR Y4I3.1.'.fifMS -ISSUANCE or sAmE PLAN TYPE Cif S7'OM 2,101m aF 1" ORCHIPA'1`IC) .a4 SF 0APLAWC;ARPX3RT 580.00 SF FWUMATED W* OF Ci()N118Tf(VC.rM14 PERMIT FEE SUMMARV 'C."ONSTRi,Yi.",i`1(?N 71-T.6 301-0i31 415-001- 9Y5.d' PLAN C:XMM. FFY, 101-000-439-318 MECHANICAL FEE U5. -if) BLECITRICAJ. 5142.64• iI'rJT30 Mt3"C.1CiN F%k -1 ;} .101 r -X41 -?31 r 5! 1,$s GRADING :1;.9, -000—f2-3-ow .Ak-V 1N ITYBUC PLACES - 0.31r,'701 -0W-255-.M DSVF3 .GPE t Yi�i1'"AG'1' FRE $3,.307 00 SUB-' 7iAL CONISTR.Ui:.'. ON AND PLAN C.MCK $3,636.70 LESS FILE -PAID FEES $0.00 Jr RECEIPT DATE BY cs i ' DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 Footings Ducts Slab Grade -0P77Return Air Steel Combustion Air Roof Deck / / Exhaust Fans O.K to Wrap F.A.U. Framing ,v g Insulation _� Q / d Compressor Vents Fireplace P.L. Grills Fireplace T.Q. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath / Da Drywall - Int. Lath Final _I til BLOCKWALL APPROVAL Final POOLS - 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 17 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 / Zg 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: =a f0e�tificate'lof-Occdpancy City of L a Buildingand.,SafetY- Department of' This Certificate issued pursuant to, the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the fol%wing; BUILDING ADDRESS: _ 57-461 SPANISH HILLS -LANE Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9907-468 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: STEVEN WALKER HOMES Address: 7161 INDIANA AVE City: RIVERSIDE, CA., 92504 By: DANIEL P. CRAWFORD JR. D Date: 6/26/2000. Building Official .i ' POST IN A CONSPICUOUS PLACE