Loading...
0307-179 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury,that I am licensed und( Chapter 9 (commencing with Section 7000) of Division 3 ofhe Professionals Code, and my License is in full force and effect. provisions of.-- Business f.-Business and License # Lic. Class f I Exp. Date " TI Datet {'� 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: Cartier Policy No. . his 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 agrJefthat if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code' I shall forthwith comply with those provisions. �`�� Warning! Failure to secure Workers' Compensatio4''coA-6 e is unlawful and shall subject an'employer to criminal penalties and!civil fines up to $1UU,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 a1 d state that the above information is correct. I agree to comply with all Cit ,y, State laws relating to the building construction, and hereby authori a representatives of this City to enter upon the above-mentioned property'�for %inspection purposes. ��Z,93F Signature (Owner/Agent) �. _ r 't r� ,I Date' '" ' — PERMIT # ' BUILDLNM--"MIT--. _ ono _--.. DATE' VALUATION .v Q, AX . LOT TRACT JOB SITE ADDRESS—.�i oCJI�� a APN OWNER CONTRACTOR / DESIGNER /hEN INEER �C.ti�IC,� �;l'1�lf�.;��k��;IC ��1Tf:;:1.�,� Y�� V� t:''•f�.CN't:) 38M UROMAR LAXE C"Al 922: FARM I?R;M.I" CA •x211 USE OF PERMIT '6J.'.MI.YR 1 ►JbY-0.M 1T.f Tl. .LYla! f4.lVJ A4, 1 - II.i.J1MLs L91u R A, rµ e!^ Lrrn,Y e.I. • •.rL.. POOL ANEVORc SPA ins IS.Xr.Rfi i+�.i.�77 E ��' :ff �ftAL{i �1dtiY �y�:/Y'�K'���1\\/A`�J1 q•�;�'{. �j��/df'�4N.. .R".Y3.,Gl:AE'A:Y�JIr .#1 i3rT4 h:��3.1pf8lV:F.AAit.'G.11� . PLAN (71-1+ECKFEE ;t 01-N(y-439m318 C-O'I3S'f.'RUCt'iON. IEE ICIT-0-00-418-00 4falf.�t WC':I OIC/1,L VEX .. &'0.01, _ 101.-000, 421 -QAC) NOD PLUNff'INOIf, POOL 1010-000419-000 MR -TOTAL AL t' O.LTJ`��'," 11-1..C1�i'� ,$7.0.Fv':r PLta2yt;MA':3;a •r�i,: e© LW5 PRE Aff)VEMS so., JUL gE CITY OF FINANf? RECEIPT DATE' 17r r BY DATE FINALED INSPECTOR , 1 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 POOLS - SPAS BLOCKWALL APPROVALS 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 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 COMMENTS: P 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) v ' 4 ' 39' 10' Spa a 12'9" 7, 13T b — ; Pool Light Pool Light Bench (1' x 5') n. ��.'rz {1 •�i Val' ..air r,'i �.. ,' ' �:•'v \ n, " r " a+.•., ly r; n . tilY7 ?7't' '�ti� . ..yn r�\S• . r Existing *:HouSi) —7, Mark & `Elsa Berk 45-350`Sunbrook' ` La Quints. CA 92253 Ph. 200-9085 Pool Size: 45'x 131611 Equipment:. i Pool Depth: 3'6 to 7' _ , Pump & Motor: Pool Surface Area: 550 scift Hayward NorthStar 1.5 HP Pool Perimeter: 106' Filter: Hayward Cartrid6e.400 sq.ft.- Spa Size: T diameter Heater: Hayward 400,000 BTU Spa Raised: 18" Salt System: Aquarite Spa Depth: 40" Spa Light: (1) 100w. white Spa water'surface area: 39 sq.ft. Pool Light: (1) 300w. white Spa perimeter: 22' ' Concrete Deck: - Jets on spa: 4 Concrete Cantilever 1' width 4 t. CITY OF LA QUINTA SUS -CONT PERMIT NUMBER OWNER BUILDER JOB ADDRESS i Only persons appearing on this list or their employees are authori ed to work m This shall b s d at all time in a UJ on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work, nd/or tth-voidance a of building permit. For each a licable trade, all information requested below must be completed b applicant. "On Fite' is not an acceptable response. ((�� .7 Trade / Classiilcetlon Contract« Stets Canvactoi s LPeense.. Workers' Co flan tnsurarice Ci Business Ucen. Company Name Classification License Number Exp. Date Carrier Name Policy Number Exp. Date License Number Exp. Date le.g. A. 8. C -BI (xxxxxxl Ixx/xx/xx) le.g. State Fund, CalCotnp) (Format Varies) (xxlxx/xx) (xxxx) (xxlxx/xxl 6rr�0 errsw <a� 0 8 �/ 6 6 ,� o 6 5 3 3� a ,a55' 7-�#x- �vr/ e r 6 �63d-J-0 /-3I-o .PTif�r�. Fv.y� 2z y_ooz'fS�77 /r ai-o FRAMING (C-51 ' 1 /-34-AO dp ee -1 a 067/7 � G1GN � GC J W Z Q DRYWALL IC -9) HVAC IC -201 ROOFING IC -391 SHEET METAL(C-431 m CD ROORING IC -151 . L m M GLAZING IC -171 C m INSULATION (C-2) LO SEWAGE NSP.'(t;-ail . . CD PAINTING IC -33) v D m CERAMIC'TiLE (C-541 r CABINETS (C -BF m N FENCING (C-13)' ' . LANDSCAPING IC -27I..": m a erim s �63d-J-0 /-3I-o .PTif�r�. Fv.y� 2z y_ooz'fS�77 /r ai-o 067/ 7 1 /-34-AO dp 067/7 Al7zr87 y -30-o Jzorc rvlyD 1 X32 oo4401s7 LL/- 1-31-