Loading...
9910-154 (RPL)LICENSED CONTRACTOR DECLARATION 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 PTofesaionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date,,f /te-J-s-167c,I "' -Signature of Contractor -� OWNER -BUILDER DECLAR ATION 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 Sectioh 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. (ti)- 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 Policy No. r� (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 thatjfj hs ould become subject/to the workers' compensation provisions of.Sec,•j�orr3_700 of the Labor Code I shall forthwith'comply with thoseprvisions.r'- ,Date:Ce Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000; in addition'to the cost of compensation, damages as provided for'in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made.to the Director of Building and. Safety for a permit subject. to the conditions .and restrictions set forth onhis application. . 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result.of.this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation: I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and.State laws rel�tog.to the building construction' and hereby authorize representativesoftbis'`City to enter upon the above' -mentioned property for inspection pipes s� i.Slg ture (Owner/Agent)r. -•^^'" Date v # BUILDING PERMIT PERMIT9910-154 DATE VALUATION "t��B3b.13E� LOT , TRACT DATE., a°1 JOB SITE I .5 W�:lrAVR104 VAL LEY APN 221,58.1-9q5 ADDRESS , OWNER CONTRACTOR / DESIGNER / ENGINEER R.C. 1-109653 dv;. SO'.11111S. ILIC,, CAUFOIRN1A MK?'US. 4a. SMS LA QUINTA C A, 92251 M12.4 DESEM)," CA 92260 (70'0)310-4X)001 M.9 55 ' USE OF PERMIT Y9., AN Qj>it..$tC SPA . LARKW/HAIMI;i11iiS SHALL BE liq PLAf:% AT s.3RE-PLAIS'4.',t3F.IWAI�',i:"l')0N. POOL AND/OR WA. 18,300.00 L33 1) LAN CHEI CK FISE s:nNS i�Lf(;4'X:3�1 F DIF ,101 -(W) -44V,-000 St 4.x!0 Xt?CUWfC AL FVM -H YQC14, 101 -MO -121-0,00 ;^4.00 L rc LAS F17,6.- x',001, :At3i: 420.000 , sis.Cv H.UmbwcJ'1~'w - vcxx, 101,QW-41,04M $27.W -0.b S:;iB-7MA11("ONSWR f UMIGN .t1'141,) ?([fCGC�c`C{�;vr di � � 'met?t..1�0 �;]".IIEEC�;7}+�;, FE- FEES DUE NOW 2f;�21.Ti4 RECEIPT DATE BY '' DATE FINALED INSPECTOR . 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 POOLS - SPAS BLOCKWALL APPROVALS Set Backs steel Electric Bond 17 f 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 v7z Gas Piping + Gas Test Appliances Final (J 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)