Loading...
0301-038 (RPL)I , LICENSED CONTRACTOR DECLARATION I hereby affirm under, enalty 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 0S 6128 C53 '=2�_11( 1/fib`ate' Signature of Contractof; '^' 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. t(_._) 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 SM9t<OMPSNVATI Policy No. 046.61.0.403 (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' compensati9n provisions of Secti n 3700 of the Labor Code, I shall forthwith comply wit,'/those,+ Irovisi nS `.,) . DateApplicant= ✓ �'-✓ e 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. l.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 properVfor inspection purposes... Signature (Owner/Agen�,'� 6 >x -• Date BUILDING PERMIT PERMIT# r #ok,-.0m ' DATE, s1--V.e.'LUgON LOT TRACT JOB SITE ADDRESS 8J..6M).r ,.MUROJI APN , OWNER CONTRACTOR / DESIGNER / EN (NEER 7;3.x;! 1 MME � WAR`LA1<r 41100 V6-100 A VNUE: 54 PAFMEMR.T CA 92260 COAI.M�A, CA 92223 i (760)398>9' 22 C.B14 00355 USE OF PERMIT POMA. PA, 18 L..K 5' J3..LOCX IVAIA,.4 CITY s"FANOf RD. I k.N.&RARR S SHALL; OF IR PIACE AT i�13, B'5 ,4'Y�' fd iA4t1f 1 TY i3 , „ i j 5 Ili, WALL F*L9ill:,ANi WOR SPA 1;,611. 0 ,Ls EISTO"TED COW 0117 CONS"MUCTIOINT Y'Iw" C119M, FIT: 101 -OW4,39-318 $128,70 001111 3'I'RUC9'ION FEB 101-000-418-000 V198.00 MECHANICAL PRE -. POOL 1191.000-471.-004 $24.00 1<d�:sXT1,,UCAJ. PR's;— POOL xnldi?Ot} ©-i#t10 .Oti PI.,t9Ia BINO.M18 POOL 101-000-419-:000 $27,00 SUB -TOTAL COMMMMON AND P1,A)T CHE M, $422.70 d.6f. 317 X .+O AW 1190 $0100 I OTAT. rFI M�1."'MM9 DUE �Ce�i► $42.2.70 RECEIPT DATE BY DATE NALE INSPEC R I 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 Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings /3 Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping �(Y PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure S,2nr Pans O.K. for Finish Plaster Sewer Lateral Sewer Connection Gas Piping Pool Cover Encapsulation�L��— -" 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: