Loading...
0306-317 (SFD)LICENSED CONTRACTOR .DECLARATION 1 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. i` License# eyy •LLi�ic. Class `f{� Exp. Da�.te{�jI / a F 1 � Fye ii • Da 'r i� _ ""Signature of Contractor OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License iLa Oor. 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 I" () I am exempt under Section B&P.C. for this reason Date Signature of Owner 4 , WORKER'S COMPENSATION DECLARATION I hereby affirm under, ,penalty of iperjury 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 1�I4'LTIONAJ, E3NKYN K Policy No. 7W310 (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 manneri sas to become subject to the workers' compensation laws• of California, and agree that if I should become subject to the workers' compensation'provisionsti ns"of Section 3700 of, the, Labor Code f I shall,forthwith comply withe'p thosrovipid 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 Sectiori 3706 of the• Labor Code, interest.and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Sal-ety— for- a permit subject to the conditions and restrictions set• forth on) his Ir application. E1! 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, inde ` nify 3 & hold harmless the City of La Quinta, its officers, agents and employteesl 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, andrhereby authorize representatives of this City to enter upon the above-mentioned°propertyefor inspection purposes. -��•Signature Owner/Agent) Date x BUILDING PERMIT PERMI' #y rl, DATE VALUATION �ii�i�yi•i.fff�. LOT TRACT =02X . JOB SITE ADDRESS OWNER 'CONTRAACTOR /t DgES`IIGgN�{ERp/ EN (NEER 'CONTRACTOR y * r-� }7� ry LLC V.TS`��..l—k 04 •ip4 A.✓'�i4 L .qtr Y"J:L-w. l:LV�t/ U, . 11 nMOGYPARKSPNT 81. «.260 1MV-14M 64"• LA QTT NII,:I'a'1. . CA' 9212,53 LA QLi11r,J' A CA. 92988 3 ,USE OF PERMIT —Cy P- f, fJ4 Ft'Lefi:{'y.S{�f;71li :.iF,ritr,Ni,(: i.!":.4" 0 6.4- 4�1',ALl.:''^`a P004 OPA. OR bRffMAN- .li PPIR.- .ACK Cr4J3d CJJ7) Ce a47.,1ti`.V 4' iA06'!' 2477,01 S POKC'H/PAVtO 221.a(' SIf O,i,a4011lOP5.sI©1Ft 172,01 SF 1a2 D'C + ' C11r C<31'dw"SL Ci Cfl !1';GiE.� �,> 1`'l�41VU.TVIM subRIMY. trOMM'RUCTION FEB 301-000.419.000 sl t( y go Puum cl;IEC .6 9, 1c:a CCI-di.yS�^328 Siy� .1° WXC!• &&CAL IrER . 3 3z F0XCTX1CP�LI 1t32.�: �aQ-Q2a',3�Q00 ffi131.•6q. PLAJM11DJU Frit. :.. ; ." , `01,.10004419.000 S9�b:t ;;?"RU'takD Adi�'f`IUi:' I�;�.: �.�all.7 1 C�? .!��-'+,,a I ••fJUJ ��:t.�i , GRAD NO F99 IMP. .� g• r; i�;'Ch 1 tLx��JL.t•�5z�'P.E..P, pp� /T••'�t�F+ll�:��' to f{ xs�9 {. y /��y�.� 4dGy 1181 1N T�. BIAC� f-Adfi'1iMn dhi° E 7.l�tJ'�&?�i�1*"S'Y�"''= t17"T 01Fri iiL C'i7i°.)1Tf l iC'l�f`:lti t)t�F kl %'lC '�: JUN 2 6 2003 -.hM P � AW.T :@TY OE LA QUINTA `IPTAL I'.. i''t1I1'�,',�1 M5 .[?�3X NO FINANCE 01=FT RECEIPT . DATE '� BY / ! D T I L INSPEPPM l -" 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 ApPikovAEs steel POOLS - SPAS 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 - 5 - Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Piaster Sewer Lateral Pool Cover Sewer Connection - Encapsulation Gas Piping Gas Test Appliances 7.- 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: