Loading...
0201-228 (RPL)U) I— N U) W Ouch d r� iY i o Z � 0. CO J ~ a. C/) N Z C0 L0 N ON U °) �Q Lo aCr 0 0 J LL J mVU O CL rn H Z ao � �d a J 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 Professionals Code, and my License is iri full force and effect. License #i Lic. Class j Exp. Date 556136 i 10 7 Signature of OWNER -BUILDER 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 �btion 3700 of the Labor Code, for the performance of the work for which this SW is issued. My workers' compensation insurance carrier & policy no. are: Carrier EXUPT Policy No. (This sedtion 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 pfovisionslof Section,370,0 of the Labor Code, I shall forthwith comply with those.provisions. / Date:`f ,fU App lica`nt­b Warning: Failure to secure Wo ke r ' Compensation` coverage is unlawful and shall subject an employer to ariIninlil.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 property for inspection, purposes. Signature (Owner/Ag Wena t) 3' -/ i �V(IA Date1( 6-? BUILDING -PERMIT PERMIT#• - DATE / ("y VALUATION LOT 0201-22.8 TRACT JOB SITE/ APN ADDRESS 4v.)-iMI.'SDIRS.RArf "CT. .. I OWNER CONTRACTOR/DESIGNER/EN (NEER MC1: MIZ JAN411130rr STINME POMS 45-C1€i5'UE`"�:RTSAM C7I 82-7 62 CUMUM" AVR L_xA ,Iulv"I'A CA. 92253 39D10 CA y2255 (760)275.6403 (MIX 160.4 USE OF PERMIT 1'001,MJOR SPA MOL .P NID SPA, 0141.v. 5J -I Ai..faB1S 5N ,PnJCIP.. { TO INSPUJI09. BOOL EQUIPMENT.I+,i<d•C=r.0 KIRK NOT 1 1C1:i1U'! h'H rrMMIT, P001, A:RiWOR SPS, 1.5,900.00 Is 31SVIAMED, COST OF, C7011`MNXIC11140N PLAN CHECK FE ` 101.000-439.318 $11].11 . CONNMI UC1,10 Ni 1,1711. 101-0100-41,118-000 MEOriMIICIA3,1" E -- P001. 161.000,42.1.000 , W;00 1z"i,.s..f�°.'1RIC P.3,.f"7L1•'. PDOLi 1c#$.•.f0rdo-,1:20-000 ?$45.00 PLtJM13%t3tI VER »- POOL. ` 101.0-419.001 $77,00 r•� FEE 0 4 � 1111 t: I ClTy0FIL40111 - a €3Y3'�C►'�'A1:.�:t)�3N,�:�£�•t�'.C',>C�2ryF;A+N�Ia ��::€ �'''` •'� �:3'?�.%5 I" 1•'.fiEe1'" 1.1m 50.00 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 BLOCKWALL APPROVALS steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS EacTestric 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 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: PA ECI:;PIr,ONr 0 811 6'6" P/ L ~CITY OF LA QUINT,,k BUILDING ,& SAFFETY DEPT. APPROVED FOR CONSTRUCTION (760) 2704403 INDIO, CA SPECIFICATIONS SPA SPECIFICATIONS SIZE 7 ' SHAPE CUSrON, JETS JAlAeISC^ FA/—. Y <J :ESERf 5♦r.:n cc uF, �A.OUIIQfA THIS DRAWNG REMAINS THE PROPERTY OP SUNRISE POOLS. REPRODUCTION OR UNAUTHORIZED USE IUTHOUT PERMISSION IS PROHIBITED. dk �Jv CITY OF ,LA QUINTA SUB-CONTRACTOR„LAST JOB ADDRESS PERMIT NUMBER OWNER BUILDER This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work 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 and/or the voidance of building r)ermit. For each aoolicable trade. all information renuested hPlnw mimt hp rmmnlatPrl by annlir.ant_ "fin FiIP” is not an arrPntnhlo raznnncP Trade / Classification Contractor State Contractor's License Workers Compensation Insurance City Business License Company Name Classification (e.g. A, B, C-8) License Number (xxxxxx) Exp. Date (xx/xx/xx) Carrier Name (e.g. State Fund, CalComp) Policy Number (Format Varies) Exp. Date (xx/xx/xx) License Number (xxxx) Exp. Date (xx/xx/xx) EARTHWORK (C-12) CONCRETE (C-8) FRAMING (C-5)"..'. STRUCT. °STEEL (C-51) MASONRY (C-29).: . PLUMBING (C-36) LATH, PLASTER (Cr35) �' �' CDCt '� 7/31 d - u Ca b - v 09 1 i �1 O DRYWALL (C-9) ELECTRICAL 1C=10Y...' ROOFING (C-39):.'..;. SHEET METAL• (C-43) . FLOORING (C=15) GLAZING: (C17);.;:;:' <.:..<::.. • . INSULATION `(C-2);.: SEWAGE'DISP::;(Q.42) PAINTING. (C733)' CERAMIC TILE .(C-54) .: CABINETS (C-6) ,.7777 FENCING ACA 3) LANDSCAPING (C47) v1 n T e C 5� C p 0 01 kqo-�.u� �e �� v� ©� �o �-13 1 Ci L