Loading...
0311-107 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and c� W Professionals Code, and my License is in full force and effect. License # Lic. ClassExp. Date Cy '7¢'x50 C53 W-11 6130105 i !f C:) Z r- Date f f j' 1� Signature of Contractor � O OWNER -BUILDER DECLARATION HW I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: Z ( ) 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 u) N Date Signature of Owner ON dQ WORKER'S COMPENSATION DECLARATION p IM I hereby affirm under penalty of .perjury one of the following declarations: Lo FZ O () 1 have and will maintain a certificate of consent to self -insure for workers' X W �: compensation, as provided for by Section 3700 of the Labor Code, for the O � Q performance of the work for which this permit is issued. _ m Q C) ( ) I have and will maintain workers' compensation insurance, as required by D 0 Q Section 3700 of the Labor Code, for the performance of the work for which this ii 0 Z permit is s uqd� Myr workers' compensation insurance c rrier & policy no. are: Carrier Policy No.� co 5 r, ('Y Q (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' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: if j t �; Applicant— Warning: pplicant Warning: Failure to secure Workers' Compensationcoverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in 110 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 �1 any permit issued as a result of this applicaton agrees to, & shall, indemnify �^Vip & 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 property for inspection purposes. USignature (Owner/Agent) ��f�rf ^ Date f .11 n1 V BUILDING PERMIT ��E,�'OX11107 DATE / r /EVALUATION ;2-SR32M) LOT TRACT c% JOB SITE '19-718 DAN DMON 17Tt IMF APN .. .. ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER MAN kOU3. (mrimiso Po uL..>llmbi (j, me 7 9-7 18 DA IRDEa [ON DR-1VE 6(27ITU QWY, RD. LA QU314ITAi. CA 92253 RALM IRPRlbiGS C -A. 9226A (760)327.7596 CSLWt 816 USE OF PERMIT POOL ANMOR RPA Y�a'OI., A faA<v/N: fiYr+T lllri PZ 4'1!try's ta`a Si EG A A AI Ca cYhrxr 146F. --R WAL4 C'IT'Y STANDARD. ALARNIRMARRIERS SHALL E'rE WhACE IV PRE-PLAS'PM ENSPECTION. 4 FL WALL 14,00 LF POOL AND/Olt SPA 74,09080 L5 '��r11MA:1[ED 0,01W OF CORSIMUCTI:0N FIAN CITECK FEE 101.000.439113 s1L:1.$0 CONSTII.UCTION HIE 101-000-418-000 $753.00 M EVIANIC.0% L FEE -- P00L 101-000421-000 $29,00 F.1.F.,CTiUC°ALFF,E.. POOL 101.000.420-000 945.00 PI.fiMMKi FF -• POOL 101.000-419-000 $"Mo STT.13-.t 0Tli1, C©NS'. RUMONI' AND P1;A4 C:HF..CrEr'. X511.80 S RE -PAW MIS 1XIS�' $0100 n (j YTAL PER M-TYM DUE NOW 0 $1511180 NOV 192003 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATE j �7 J ��t" (y BY ( L" ` DAT FINALE/(—E OR r ✓ s 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 Firewali Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Shower Pans Sewer Lateral Equipment Enclosure n C✓ — O.K for Finish Plaster Pool Cover Sewer Connection Encapsulation Gas Piping 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: