Loading...
0208-247 (RPL)LICENSED CONTRACTOR DECLARATION ,p I he 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 fofce and effect. License # Lic. Class Exp. Date � 7.131123 B i'..8��i1>� �° JI'�f� Date �� ? ri Signature of Contractor OWNER -BUILDER DECL R I©IN 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 perfpymance of the work for which this permit is issued. X(r) 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 STATE FUND Policy No. )SPO, " (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, loshall forthwith comply'with those provisionk., Date'.` 4.-,� . /r' ' APPlicant�— 1! / t�.� 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 ariy 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/6f this City to enter upon t the above-mentioned property foynspection purp/.�op (,Ile, j f Sinature (Owner/Ageni)-_--- d✓' Y K/�_+ Date BUILDING PERMIT PERMIT# 0203-2Q? DATE, r� VALUATION $fie: npyn LOT TRACT JOB SITE ADDRESS 4.4,4010 DMi IZT S''f; X DRIVE APN OWNER CONTRACTOR / DESIGNER / EN INEER 121M PW_R.MM hTP :EY1 "MPRMS 45-010 DE BERT FOZ Dk 45-260 PALM St... Imo, QViVrA CA 92253 iNDIO CA 512201 (160).147-8913 C'i3W 4.998 USE OF PERMIT POOH. AND/GR SPA POOL ONLY, Af.&t2:Mi/3.ARS0&R3^ SHALL HE IW PLACE PRIOR TO Pita:-1111/ASTF.&t INSPECTIO14 P00,LA1gDIOR$PA. ls,000,001,S `I]MAITLD COST OF t':C-yiV'MMMON �:t,043�3t�3 PLM CHECK RE 101-,000-439.31€ $105,30 CONt3'i'3 IXT10Ti P'FIW 101-000-418-000 $162.00 MECHA.21I L'flEE — POOL 101.000.421.000 SAW Es 1.d?t CTRiCA L MY, .. POOL 101-000-420-000 $t4 --s.40 Is1A RAVING KI 1100L 101.000.419-000 L u �. A6_!r, 2 3 Ziu'132 CITY OF LA QUINTA FINANCE .. �t71Ii1C°7'Se7�i A1�"l P,iak�1fi.I;' L'.�:.115 PRE >:P,r1ti D F r". $0.0 $OT T, PERAW FFIXIS DUE now RECEIPT Z DATE BY FWAAbf INSP t. w I.;, INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 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 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 Sewer Connection Pool Cover 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)