Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
9907-585 (SFD)
LICENSED CONTRACTOR 'DECLARATION I herebv affirm udder penalty of periurV -that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Prafessionals Code, and my License is in full force and effect. License # Lic. Class 'Exp. Date 0, 112(1,1 ate �% Signature of Contractor,►- - s 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. „ (01 I'have and will maintain workers' compensation insurance, as required by Secii"on 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' �conipensation insurance carrier &policy no. are: Carrier Policy No. (This section need not be completed.if the permit valuation.is for $100.00 or less). ( I certify that in the performance of the workfor 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'shalh orthwlt comply with those provisions. ¢ate: .f 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 propertyffor inspection purposes ' OIg ture (Owner/Agent) - f Date 4� HUMP ERMIT PERMIT# . DATE VALUATION LOT TRACT 1i��f ..7/19.9 .$12i -A47.40 3 . �:394i5-F aid" d?� L JOB SITE ADDRESS. 78^169.81t"lROOk LAN FAPN OWNER CONTRACTOR/DESIGNER/ENGINEER 12€32 W. AR t.OW J-1dGHWA Y 1,281W AR,1,'it' W HWY UPLAND CA 91785 UPLAND CA 9,V785 CBL.# 3318 USE OF PERMIT r 'cam .F: FAINNVY n4v>;:.LUNG ..5`FD- i.LW 37, PLAN 4C -k -PERMIT DOnl, ' N_ t.iF}'i;:1,C rE BLCKU, WFii L OR POOL. 7S'rr.a ri�rJy2�pQ� t7�i].t2L.t`uq i"�9�ek Fic �p'cm M,xil..'3'.i'k�i.t'n� . / ,�ijT(y�` d' SUL]F.7(MI O1'' SA'�M PLA; �`Y• lT8 TZ, T..R A(;T CO115 "iit;)'( i'l(0 2J*8100 SF plowe r(o a.t)O Sri (JAR.AWCARPOR.:i' 3R3.i' SF EST'MATES C= OF C0N% KI1C`f10TV P ILMI' FEE SUINMUA11 V CONST.MICTION FEE FL. ALd'CHECK FES 2Jtt19XCTRICALbs.Wd4 PLi rMUNG'? FIVE S;FtONC S1tii'3CJ F'1,-:LSFEi4C) til.Qt =�lq3@ $:1,�.0f, :'§iR D7t 10 FETE 1 fa J -tTt}Q3- X23-13013 1 + ARt'�.':iN i'�U BLIC PLA(.°FS'- �'E,SU; 'Z(Jl. 9Jt� 2��-tu14 £� 1.� 1 � »_ � t-,' i7F�-LOPFf23Tv PAC Y -ME t CYT, r - St -0-1 "iTAL CONW—Rt7i.`TIO.V.ANDr PLAN CHECK Y $3,176,91. . �r� .LrS: Ff\ N't�t" Li�O.:.'t $0.00 l��1..d$6F4 "406,3x® RECEIPT DATE BY �i9` DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings p _ _ 6'� Ducts Slab Grade _ Return Air Steel Combustion Air Roof Deck _0_1_0er_ ©�' Exhaust Fans O.K. to Wrap Framing `/ �( F.A.U. Compressor Insulation L. - z - 60 1 Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath - tCVo Xg Drywall - Int. Lath Z. ? _ CO 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 Q — 9_9_ e zle- Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral (- ZG -mooR Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test _ Appliances Final COMMENTS: 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) -1to -Q MAR -09-2000 15:53 WESTERN INSULATION 909 686 8796 P,26/227 ww MAD rap d 4711 lathe- 8tlsot, M"mida, Calftnie 97501 TeL (909) 686-8760 Pax (909) 686.8786 INSULATION CERTIE'ICA THIS IS TO' CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24, STATE OF CAUFORNIA, IN THE BUILDING LOCATED AT: . TRACT / PHASE: DESERT PRIDE - TRACT 923996-1 LOT# 37 P44,V -V SITE ADDRESS: 76-780 SUNBROOK•LANE LA QUINTA, CA 92253 EXTERIOR WALLS " MANUFACTURER: Johns -Manville THICKNESS. 35/8°.R -VALUE: R-13 CEILINGS: BATTS ®LO MANUFACTURER: GREENSTONE THICKNESS: B.1" R—VALUE: R•30 GENERAL CIGdTRAC'1•AR: AMERICAN COMMUNITIES LICENSE NUMBER: BY: TITLE: DATE: INSULATION _C NTRACT-OR: WESTERN INSULATION, INC. LICENSE NUM ER: 481278 BY: TITLE: RO ION MANA DATE MARCH 9, 2000