The URL can be used to link to this page

0009-071 (MISC)LICENSED CONTRACTOR DECLARATION Nere_!Iy affirm under penalty of perjury that I am licensed under provisions of Vnapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. % License # Lic. Class Exp. Date P407B C' tial Date 00 Signature of Contractor- OWNER-BUILDER ontractor 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. ( ) 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. (W15-0007338 (This section need not be completed if the permit valuation is for $100.00 or less). - () I certify that in the performance of the wormerNch this permit is issued, I shall not employ any person in any manner'so as to�become�bje jt to the workers' compensation laws of California', and agree that if lyshould become subject to the workers' compensation provisions of Section 3700 of the Labojr, Code, I shall'forth,Ath comply with those �rovisions� LI �---' Date: -7 ✓ s'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 fora 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 witFrall\City, and $,tate laws relating to the building construction, and hereby authorize\repres ntatives of this City to enter upon the above-mentionedproperty for inspection purpose . Signature (Owner/A6ent)�7 �° Dater '( - UILDING PERMIT PERMIT# DAJ!/� �} /C�VALUATION LOT Q'®TRACT $UMBO 27840 JOB SITE APN - ADDRESS 48-50D WASMN a�TON .Mr-IIrr i 49-I ow � OWNER CONTRACTOR/DESIGNER/ENGINEER mDOM 7j11t1. L.C3RAM1' Sl'ARKSCOPaSTRUC1TOad' PC) BOX, 1716 79-295 MANCHO LA Qt=A DR LA. Q`c31NytA CA. 92253 LA Qt}-UgTA CA 92.253 �'1t9(3) 71 a19!i1 ; CRU 2996" USE OF PERMIT Ivll'aC..IAAi�GUS NON ST.RUC.`TORAL RIyMOrDE .AND MN'LrSfRATIO'N Clumar-z TO Lt3TRY MTHEHOtiSE AS PER APPPROv 8,0 PLANS ONLY i VALUATION VWWWA,TED C;C)ST OV u'flL`1'i 2'E3'MOtN Iili)rJ.i3t3 PRTHW T' rte+.' siT.fl PLM CHECK ME 101--000-439-338 CONSTRU ION M, 1.61-000-418-000 $72.00 MECHANICAL. FEE -- POOL 101--000-421.000 $24;00 ELECTRICAL FFE - POOL 101-000-420-000 PLUlVl1dINC! SS+/:"t'"'.ii.1, 101-00,0-419-000 s6 fea® y pR SEP m.�.t. - �v SUB -TOTAL CONOTRUC71ag ANTIPLAR CfMCLCx i$2.1d.80 L-2.313 PRE -PAM I'M13 $t). o 4 M AyFEjrMDDENOW �4(4 2 RECEIPT DATE ' BY DATE FINALE 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 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall 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 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 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: IF /I Bin City of La Quinta Building at Safety Division P.O. Box 1504 Permit Ai 78-495 Calle Tampico La Quinta, CA 92253 Building Permit Application and Tracking Sheet Project Address:�j 5-0 6a*# 6 S Owner's Name: —11722e:9 A. P. Number: / o QL-) oCp'D Address: /-t) 1 �/ TNKT2? NO Legal Description: %� t �,�Tit , &,47 -OUS� Ciry,ST, Zip: Z '2 3 Contractor: �l -K Sw .tel T Telephone: -7 7 / / S Address: �� Project Description: Cin.ST, Zip: ¢ S 2 e �- '� /Vp / v �eco Telephone: State Lic. City Lic. sleBOJ S� Arch.. Engr.. Designer: 4-.04 M (3oo-7i / Address: City• ST. Zip: Telephone: 3 Construction Type: Occupancy: State Lic. Project type (circle one): New Add'n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: # Units: Telephone = of Contact Person: P % / / � � rJ Estimated Value of Project: p pc) -- APPUCA IT. DQ #SOT YIfR TE -BELOW THIS LINE- :... q Submittal Rec, :TBAf3f G PERMIT;irh'E5 Plan sets Ptaa Cdeeksuhmittedf >3{ Item Arnoeat Structural>Cslq Rsxfewed,:sead7 for.ccrrectioas PUn,:CLeckDeposit.. Trans Cates:,: GilkdCa¢tacti a sen Plan , he an Title 24 Cshx Plaiisptckcd ug.. Censttuctiott Great Deed';; Plaaa raaubmttied Mechankeni: School Fees: Reviewed, scady.t9,iutttx :::. Etrettatstl subcontactors; ist 7-7777 Called Cot:tatt Perera Plumbiag. Contractor:Irifn D�[e�f;►era�itivar:: 5 hLX Ciy Business it L Crikd Workers' Comp .. :;.. rws.s...,sy.......... ...... Cityo La - uznta Developers Project Approval Form Prior to the issuance of Building Permits for the project listed below, the following Departmental clearances must be obtained. Please return this form to Nickie Gormley in the Building and Safety Department only g4ter annroval. Contact applicant for resolution of conditions preventing or delaying approval. Project: Remodel. to Entry Gatehouse at Washington Street. Non-structural changes and Fenestration changes. (Plans in the building department). Applicant Contact: Nolan Sparks, Sparks ',Construction, 771-1941 Application / Circulatio ate: 9/5/00 UU Date Community Dev t Department Christine Di Iorio, mung Manager Date Public Works Department Steve Speer, Senior Engineer Date Building and Safety Department Greg Butler, Building. and Safety Department Manager Date.. Health Department Date Fire Department Date Schools Fees Paid Cio Ltya uinta Developers Project Approval Form Prior to the issuance of Building Permits for the project listed below, the following Departmental clearances must be obtained. Please return this form to Nickie Gormley in the Building and Safety Department only i(fter approval. Contact. applicant for resolution of conditions preventing or delaying approval. Project: Remodel to Entry Gatehouse at Washington Street. Non-structural changes,and Fenestration changes. (Plans in the building department). Applicant Contact: Nolan Sparks, Sparks Construction, 771-1941 Application / Circulation Date:.9/5MO Date Community Development Department Christine Di Iorio, Planning Manager Date Public Works Department 1�0 . ` p aLeve apeer, aemor engineer Building and Safety Department Greg Butler, Building and Safety Department Manager Health. Department Date Fire Department Schools Feis..Paid Date 0 Date